Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis

Autor: Michaela Sagova, Adelheid Gauly, Bernard Canaud, Andreas Maierhofer, Ralf Wojke, Malte Gross
Přispěvatelé: Fresenius Medical Care-DS, Fresenius Medical Care [Bad Homburg], Laboratoire de Cristallographie et Cristallogénèse des Protéines (LCCP), Institut de biologie structurale (IBS - UMR 5075 ), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Universitätsklinikum Ulm - University Hospital of Ulm, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
dialysis fluid
medicine.medical_treatment
Sodium
0206 medical engineering
Population
Biomedical Engineering
Urology
Medicine (miscellaneous)
Diuresis
chemistry.chemical_element
Bioengineering
02 engineering and technology
030204 cardiovascular system & hematology
Thirst
Biomaterials
03 medical and health sciences
0302 clinical medicine
Main Text Articles
Renal Dialysis
Dialysis Solutions
medicine
Humans
Prospective Studies
Precision Medicine
education
Dialysis
Aged
education.field_of_study
Main Text Article
hemodialysis
Cross-Over Studies
General Medicine
Middle Aged
020601 biomedical engineering
Crossover study
Confidence interval
3. Good health
chemistry
Kidney Failure
Chronic
Female
Hemodialysis
medicine.symptom
automated sodium adjustment
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Algorithms
Zdroj: Artificial Organs
Artificial Organs, 2019, 43 (10), pp.1002-1013. ⟨10.1111/aor.13463⟩
Artificial Organs, Wiley, 2019, 43 (10), pp.1002-1013. ⟨10.1111/aor.13463⟩
ISSN: 1525-1594
0160-564X
Popis: International audience; In standard care, hemodialysis patients are often treated with a center-specific fixed dialysate sodium concentration, potentially resulting in diffusive sodium changes for patients with plasma sodium concentrations below or above this level. While diffusive sodium load may be associated with thirst and higher interdialytic weight gain, excessive diffusive sodium removal may cause intradialytic symptoms. In contrast, the new hemodialysis machine option "Na control" provides automated individualization of dialysate sodium during treatment with the aim to reduce such intradialytic sodium changes without the need to determine the plasma sodium concentration. This proof-of-principle study on sodium control was designed as a monocentric randomized controlled crossover trial: 32 patients with residual diuresis of ≤1000 mL/day were enrolled to be treated by high-volume post-dilution hemodiafiltration (HDF) for 2 weeks each with "Na control" (individually and automatically adjusted dialysate sodium concentration) versus "standard fixed Na" (fixed dialysate sodium 138 mmol/L), in randomized order. Pre- and post-dialytic plasma sodium concentrations were determined at bedside by direct potentiometry. The study hypothesis consisted of 2 components: the mean plasma sodium change between the start and end of the treatment being within ±1.0 mmol/L for sodium-controlled treatments, and a lower variability of the plasma sodium changes for "Na control" than for "standard fixed Na" treatments. Three hundred seventy-two treatments of 31 adult chronic hemodialysis patients (intention-to-treat population) were analyzed. The estimate for the mean plasma sodium change was -0.53 mmol/L (95% confidence interval: [-1.04; -0.02] mmol/L) for "Na control" treatments and -0.95 mmol/L (95% CI: [-1.76; -0.15] mmol/L) for "standard fixed Na" treatments. The standard deviation of the plasma sodium changes was 1.39 mmol/L for "Na control" versus 2.19 mmol/L for "standard fixed Na" treatments (P = 0.0004). Whereas the 95% CI for the estimate for the mean plasma sodium change during "Na control" treatments marginally overlapped the lower border of the predefined margin ±1.0 mmol/L, the variability of intradialytic plasma sodium changes was lower during "Na control" versus "standard fixed Na" treatments. Thus, automated dialysate sodium individualization by "Na control" approaches isonatremic dialysis in the clinical setting.
Databáze: OpenAIRE
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