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首页> 外文期刊>Artificial Organs >Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis
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Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis

机译：透析液钠浓度的自动互核浓度降低了血液透析的脑内血浆钠变化

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Abstract 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.
机译：摘要在标准护理中，血液透析患者通常用中心特异性固定透析钠浓度治疗，可能导致血浆钠浓度低于或高于该水平的患者的扩散钠变化。虽然衍射钠载荷可能与口渴和更高的间型重量增益相关，但过量的衍射钠去除可能导致细胞内症状。相比之下，新的血液透析机选择“Na控制”在治疗过程中提供透析钠钠的自动互化，其目的是降低这种细胞发育性钠的钠变化而不需要确定血浆钠浓度。这种原则上钠对照的研究被设计为单眼随机控制的交叉试验：32例残留利尿患者≤1000Ω·毫升/天的患者被高批量稀释血液过滤（HDF）进行2每周几周，“Na控制”（单独和自动调节透析钠浓度）与随机顺序的“标准固定Na”（标准固定Na“（固定透析钠138×mmol / L）。通过直接电位测定，在床侧测定透析后血浆钠浓度。研究假设由2个组分组成：治疗的起始和结束之间的平均血浆钠变化在±1.0？mmol / L之间用于钠控制处理，血浆钠变化的较低变化为“NA控制”用于“标准固定NA”治疗方法。分析了31例成年慢性血液透析患者（意向治疗群体）的三百七十二治疗。用于平均血浆钠变化的估计是0.53？mmol / L（95％置信区间：[α1.04;α02] mmol / l）用于“Na对照”处理和？0.95？mmol / L（95％Ci： [？1.76;α015] mmol / l）用于“标准固定NA”处理。血浆钠变化的标准偏差为1.39？mmol / l用于“Na控制”，对“标准固定NA”处理的2.19毫克/ L（p？= 0.0004）。虽然在“Na控制”治疗期间，95％CI用于估计的平均血浆钠变化，但在预定义边距的下边界±1.0±1.0×1.0摩尔/升的下边界，在“NA对照”期间，细胞内血浆钠变化的可变性较低与“标准固定NA”治疗。因此，通过“NA对照”在临床环境中接近异畸形透析的自动透析钠个体化。

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