Hypotension during hemodialysis is still an unsolved problem. The treatment of patients with cardiovascular instability is efficaciously carried out with the use of ‘profiled dialysis’ (PD) with computerized modulation of ultrafiltration and conductivity. We tested a new profile model which involves progressive decrease of ultrafiltration associated with variable conductivity (‘bell pattern’). We observed 8 stable long-term patients receiving hemodialysis (4 men and 4 women, mean age 63.5 years) for 4 h three times a week. Before our test, sodium balance had reached a steady state in all patients and remained stable during the entire observation period. The sodium balance was established by means of a simple pattern suggested by Ursino and coworkers. The patients were observed for two periods of 1 month each (protocols A and B). The intradialytic mean arterial pressure was studied, checking every hour of dialysis. Statistical analysis was done by ANOVA for repeated measures. We compared standard dialysis with constant ultrafiltration rate and conductivity (protocol A) with sessions performed involving a progressive decrease of ultrafiltration together with a variable conductivity of –0.2, +0.2, +0.6, +0.6, 0, –0.4, –0.4, and –0.4 mS/s (protocol B). We found a lower incidence of hypotension (p < 0.01) with better cardiovascular stability during and after treatment in ‘profiled dialysis’.

Keywords:
Sodium modelling, Dialysis ultrafiltration profiles, Dialysis sodium profiles
1.
Peticlerc T, Drueke T, Man NK, Funck-Brentano JL: Cardiovascular stability on hemodialysis. Adv Nephrol Necker Hosp 1987;16:351–370.
2.
Stiller S, Mann H: Ultra-short dialysis and internal physiologic resistance. ASAIO Trans 1987;33:754–757.
3.
Fleming SJ, Wilkinson JS, Greenwood RN, Aldridge C, Baker LR, Cattell IJR: Effect of dialysate composition on intercompartmental fluid shift. Kidney Int 1987;32:267–273.
4.
Martin-Malo A, Perez R, Gomez J, Burdiel LG, Andres E, Castillo D, Moreno E, Aljama P: Sequential hypertonic dialysis. Nephron 1985;40:458–462.
5.
Splendiani G, et al: Emodialisi sequenziale: isotonica ipotonica. Nefrol Dial 1982;3:209–213.
6.
Peticlerc T, Man NK, Funck-Brentano JL: Sodium modeling during hemodialysis: A new approach. Artif Organs 1984;8:418–422.
7.
Sturniolo A, Costanzi S, Barbera G, Ruffini MP, Passalacqua S, Fulignati P, Splendiani G: Computerised monitoring of sodium and fluid during haemodialysis. Nephrol Dial Transplant Suppl 1990;1:162–164.
8.
De Vries PMJM: Plasma volume changes during hemodialysis. Semin Dial 1992;5:42–47.
9.
Raja R, Kramer M, Barber K, Chen S: Sequential changes in dialysate sodium during hemodialysis. ASAIO J. 1988;29:649–651.
10.
Locatelli et al: Cinetica del sodio in emodialisi: un modello semplificato. Atti Soc Ital Nefrol 1991:1099–1103.
11.
Di Filippo S, Corti M, Andrulli S, Pontoriero G, Manzoni C, Locatelli F: Optimization of sodium removal in paired filtration dialysis by single-pool sodium and conductivity kinetic models. Blood Purif 1997;15:34–44.
12.
Po CL, Afolabi M, Raja RM: The role of sequential ultrafiltration and varying sodium on vascular stability during hemodialysis. ASAIO J 1993;39:798–800.
13.
Ursino M, Colì L, La Manna G, Grilli Cicilioni M, Dalmastri V, Giudicassi A, Casotti P, Avanzolini G, Stefoni S, Bonomini VA: Simple mathematical model of intradialytic sodium kinetics: ‘In vivo’ validation during hemodialysis with constant or variable sodium. Int J Artif Organs 1996;19:393–403.
14.
Locatelli F, Ponti R, Pedrini L, Costanzo R, Di Filippo S, Marai P, Pozzi C: Sodium kinetics across dialysis membranes. Nephron 1984;38:174–177.
15.
Bonomini V, Colì L, Scolari MP: Profiling dialysis: A new approach to dialysis intolerance. Nephron 1997;75:1–6.
16.
Colì L, Bonomini M, La Manna G, Dalmastri V, Ursino M, Ivanovich P, Bonomini V: Clinical use of profiled hemodialysis. Artif Organs 1998;22:724–730.
17.
Ursino M, Colì L, Brighenti C, De Pascalis A, Chiari L, Dalmastri V, La Manna G, Mosconi G, Avanzolini G, Stefoni S: Mathematical modeling of solute kinetics and body fluid changes during profiled hemodialysis. Int J Artif Organs 1999;22:94–107.
18.
Colì L, Ursino M, Dalmastri V, La Manna G, Avanzolini G, Stefoni S, Bonomini V: A simple mathematical model applied to selection of sodium profile during profiled hemodialysis. Nephrol Dial Transplant 1998;13:404–416.
19.
Schneditz D, Roob J, Oswald M, Pogglitsch H, Moser M, Kenner T, Binswanger U: Nature and rate of vascular refilling during hemodialysis and ultrafiltration. Kidney Int 1992;42:1425–1433.
20.
Santoro A: L’instabilità cardio-vascolare intradialitica: le aspettative derivanti dalle nuove risorse tecnologiche. G Ital Nefrol 1999;3:282–293.
© 2001 S. Karger AG, Basel
2001
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