Associations between dialysate sodium concentration and plasma sodium concentration of dogs receiving intermittent hemodialysis treatments

Jonathan D. Foster Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

Search for other papers by Jonathan D. Foster in
Current site
Google Scholar
PubMed
Close
 VMD
,
Kenneth J. Drobatz Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

Search for other papers by Kenneth J. Drobatz in
Current site
Google Scholar
PubMed
Close
 DVM, MS
, and
Larry D. Cowgill Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Search for other papers by Larry D. Cowgill in
Current site
Google Scholar
PubMed
Close
 DVM, PhD

Abstract

OBJECTIVE To compare dialysate sodium concentration and patient plasma sodium concentration of dogs during intermittent hemodialysis treatments.

SAMPLE 211 intermittent hemodialysis treatments performed on 40 client-owned dogs for the management of dialysis-dependent uremia.

PROCEDURES Medical records were reviewed to determine the plasma sodium concentration of each dog before and after routine hemodialysis treatments. Associations between detected changes in plasma sodium concentration and dialysate sodium concentration were evaluated by use of Spearman rank correlations and linear regression analysis.

RESULTS Significant linear correlations were found between the dialysate sodium concentration and patient sodium concentration. The starting dialysate-to-patient sodium gradient was associated with the strongest correlation to the change in patient sodium concentration at the end of the dialysis session. Modest correlations existed between the dialysate sodium concentration and postdialysis patient sodium concentration as well as between the predialysis dialysate-to-patient sodium gradient and postdialysis dialysate-to-patient sodium gradient.

CONCLUSIONS AND CLINICAL RELEVANCE The dialysate sodium concentration was correlated with the patient sodium concentration in dogs, and the dialysate-to-patient sodium gradient could be used to further refine this association to predict the postdialysis patient sodium concentration and potentially manage dysnatremia during hemodialysis. Prospective studies should be performed to determine how these associations can be used to correct aberrations as well as to avoid unwanted alterations in patient sodium concentrations.

Abstract

OBJECTIVE To compare dialysate sodium concentration and patient plasma sodium concentration of dogs during intermittent hemodialysis treatments.

SAMPLE 211 intermittent hemodialysis treatments performed on 40 client-owned dogs for the management of dialysis-dependent uremia.

PROCEDURES Medical records were reviewed to determine the plasma sodium concentration of each dog before and after routine hemodialysis treatments. Associations between detected changes in plasma sodium concentration and dialysate sodium concentration were evaluated by use of Spearman rank correlations and linear regression analysis.

RESULTS Significant linear correlations were found between the dialysate sodium concentration and patient sodium concentration. The starting dialysate-to-patient sodium gradient was associated with the strongest correlation to the change in patient sodium concentration at the end of the dialysis session. Modest correlations existed between the dialysate sodium concentration and postdialysis patient sodium concentration as well as between the predialysis dialysate-to-patient sodium gradient and postdialysis dialysate-to-patient sodium gradient.

CONCLUSIONS AND CLINICAL RELEVANCE The dialysate sodium concentration was correlated with the patient sodium concentration in dogs, and the dialysate-to-patient sodium gradient could be used to further refine this association to predict the postdialysis patient sodium concentration and potentially manage dysnatremia during hemodialysis. Prospective studies should be performed to determine how these associations can be used to correct aberrations as well as to avoid unwanted alterations in patient sodium concentrations.

Contributor Notes

Dr. Foster's present address is Friendship Hospital for Animals, 4105 Brandywine St NW, Washington, DC 20016.

Address correspondence to Dr. Foster (jdfoster@friendshiphospital.com).
  • 1. Guillaumin J, DiBartola SP. Disorders of sodium and water homeostasis. Vet Clin North Am Small Anim Pract 2017;47:293312.

  • 2. Langston C. Managing fluid and electrolyte disorders in kidney disease. Vet Clin North Am Small Anim Pract 2017;47:471490.

  • 3. Funck-Brentano JL, Man NK. Optimization of Na content of dialysis fluid. Nephron 1984;36:197200.

  • 4. Flanigan MJ, Khairullah QT, Lim VS. Dialysate sodium delivery can alter chronic blood pressure management. Am J Kidney Dis 1997;29:383391.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. De Nicola L, Bellizzi V, Minutolo R, et al. Effect of dialysate sodium concentration on interdialytic increase of potassium. J Am Soc Nephrol 2000;11:23372343.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Movilli E, Camerini C, Gaggia P, et al. Role of dialysis sodium gradient on intradialytic hypertension: an observational study. Am J Nephrol 2013;38:413419.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Thomson BKA, Huang S-HS, Leitch RE, et al. Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis. Hemodial Int 2013;17:548556.

    • Search Google Scholar
    • Export Citation
  • 8. Pedrini LA, Ponti R, Faranna P, et al. Sodium modeling in hemodiafiltration. Kidney Int 1991;40:525532.

  • 9. Flanigan MJ. Role of sodium in hemodialysis. Kidney Int Suppl 2000;76:S72S78.

  • 10. Song JH, Lee SW, Suh C-K, et al. Time-averaged concentration of dialysate sodium relates with sodium load and interdialytic weight gain during sodium-profiling hemodialysis. Am J Kidney Dis 2002;40:291301.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Santos SFF, Peixoto AJ. Revisiting the dialysate sodium prescription as a tool for better blood pressure and interdialytic weight gain management in hemodialysis patients. Clin J Am Soc Nephrol 2008;3:522530.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Redaelli B, Sforzini S, Bonoldi G, et al. Hemodialysis with “adequate” sodium concentration in dialysate. Int J Artif Organs 1979;2:133140.

    • Search Google Scholar
    • Export Citation
  • 13. Kim M-J, Song JH, Kim GA, et al. Optimization of dialysate sodium in sodium profiling haemodialysis. Nephrology (Carlton) 2003;8(suppl):S16S22.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. de Paula FM, Peixoto AJ, Pinto LV, et al. Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int 2004;66:12321238.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Hecking M, Karaboyas A, Saran R, et al. Dialysate sodium concentration and the association with interdialytic weight gain, hospitalization, and mortality. Clin J Am Soc Nephrol 2012;7:92100.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Farber SJ, Schubert M, Schuster N. The binding of cations by chondroitin sulfate. J Clin Invest 1957;36:17151722.

  • 17. Nguyen MK. Quantitative interrelationship between Gibbs-Donnan equilibrium, osmolality of body fluid compartments, and plasma water sodium concentration. J Appl Physiol 2006;100:12931300.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Edelman IS, Leibman J, O'Meara MP, et al. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest 1958;37:12361256.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Flythe JE, McCausland FR. Dialysate sodium: rationale for evolution over time. Semin Dial 2017;30:99111.

  • 20. Jaffrin MY, Fenech M, de Fremont J-F, et al. Continuous monitoring of plasma, interstitial, and intracellular fluid volumes in dialyzed patients by bioimpedance and hematocrit measurements. ASAIO J 2002;48:326333.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21. Sarkar SR, Wystrychowski G, Zhu F, et al. Fluid dynamics during hemodialysis in relationship to sodium gradient between dialysate and plasma. ASAIO J 2007;53:339342.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. Moissl U, Arias-Guillén M, Wabel P, et al. Bioimpedance-guided fluid management in hemodialysis patients. Clin J Am Soc Nephrol 2013;8:15751582.

  • 23. Scheltinga MR, Helton WS, Rounds J, et al. Impedance electrodes positioned on proximal portions of limbs quantify fluid compartments in dogs. J Appl Physiol 1991;70:20392044.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Polaschegg HD. Automatic, noninvasive intradialytic clearance measurement. Int J Artif Organs 1993;16:185191.

  • 25. Locatelli F, Di Filippo S, Manzoni C, et al. Monitoring sodium removal and delivered dialysis by conductivity. Int J Artif Organs 1995;18:716721.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26. Kumar S, Khosravi M, Massart A, et al. Are serum to dialysate sodium gradient and segmental bioimpedance volumes associated with the fall in blood pressure with hemodialysis? Int J Artif Organs 2014;37:2128.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Davenport A. Negative dialysate to sodium gradient does not lead to intracellular volume expansion post hemodialysis. Int J Artif Organs 2010;33:700705.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement