Sodium, volume and pressure control in haemodialysis patients for improved cardiovascular outcomes
| Autor: | Stefano Stuard, Ulrich Moissl, Bernard Canaud, Jule Pinter, Charles Chazot |
|---|---|
| Přispěvatelé: | University Hospital of Würzburg, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Sodium medicine.medical_treatment [SDV]Life Sciences [q-bio] Volume overload Water-Electrolyte Imbalance chemistry.chemical_element Reviews Context (language use) 030204 cardiovascular system & hematology time-averaged fluid overload 03 medical and health sciences Therapeutic approach 0302 clinical medicine bio-impedance spectroscopy cardiovascular disease Renal Dialysis Internal medicine Extracellular fluid medicine Humans sodium metabolism 030203 arthritis & rheumatology Transplantation business.industry medicine.disease 3. Good health haemodialysis Blood pressure chemistry Nephrology Cardiovascular Diseases Cardiology Kidney Failure Chronic Hemodialysis Hypotension business Kidney disease |
| Zdroj: | Nephrology Dialysis Transplantation Nephrology Dialysis Transplantation, Oxford University Press (OUP), 2020, 35 (Supplement_2), pp.ii23-ii30. ⟨10.1093/ndt/gfaa017⟩ |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfaa017⟩ |
| Popis: | Chronic volume overload is pervasive in patients on chronic haemodialysis and substantially increases the risk of cardiovascular death. The rediscovery of the three-compartment model in sodium metabolism revolutionizes our understanding of sodium (patho-)physiology and is an effect modifier that still needs to be understood in the context of hypertension and end-stage kidney disease. Assessment of fluid overload in haemodialysis patients is central yet difficult to achieve, because traditional clinical signs of volume overload lack sensitivity and specificity. The highest all-cause mortality risk may be found in haemodialysis patients presenting with high fluid overload but low blood pressure before haemodialysis treatment. The second highest risk may be found in patients with both high blood pressure and fluid overload, while high blood pressure but normal fluid overload may only relate to moderate risk. Optimization of fluid overload in haemodialysis patients should be guided by combining the traditional clinical evaluation with objective measurements such as bioimpedance spectroscopy in assessing the risk of fluid overload. To overcome the tide of extracellular fluid, the concept of time-averaged fluid overload during the interdialytic period has been established and requires possible readjustment of a negative target post-dialysis weight. 23Na-magnetic resonance imaging studies will help to quantitate sodium accumulation and keep prescribed haemodialytic sodium mass balance on the radar. Cluster-randomization trials (e.g. on sodium removal) are underway to improve our therapeutic approach to cardioprotective haemodialysis management. |
| Databáze: | OpenAIRE |
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