Effect of a Plasma Sodium Biofeedback System Applied to HFR on the Intradialytic Cardiovascular Stability. Results from a Randomized Controlled Study

Overview

Journal Nephrol Dial Transplant

Publisher Oxford University Press

Specialties General Surgery
Nephrology

Date 2012 May 8

PMID 22561583

Citations 11

Authors

Francesco Locatelli

Sergio Stefoni

Thierry Petitclerc

Luigi Coli

Salvatore di Filippo

Simeone Andrulli

Christine Fumeron

Giovanni Maria Frasca

Sibilla Sagripanti

Silvana Savoldi

Andrea Serra

Carmine Stallone

Filippo Aucella

Antonio Gesuete

Antonio Scarlatella

Francesco Quarello

Paola Mesiano

Peter Ahrenholz

Roland Winkler

Lise Mandart

Joan Fort

Christian Tielemans

Carlo Navino

Affiliations

Soon will be listed here.

Abstract

Background: Intradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH.

Methods: Fifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment. HFR-Aequilibrium (HFR-Aeq) is an evolution of the haemofiltration with endogenous reinfusion (HFR) dialysis therapy, with dialysate sodium concentration and ultrafiltration rate profiles elaborated by an automated procedure. The primary end point was the frequency of IDH.

Results: Symptomatic hypotension episodes were significantly lower on HFR-Aeq versus HFR (23 ± 3 versus 31 ± 4% of sessions, respectively, P l= l0.03), as was the per cent of clinical interventions (17 ± 3% of sessions with almost one intervention on HFR-Aeq versus 22 ± 2% on HFR, P <0.01). In a post-hoc analysis, the effect of HFR-Aeq was greater on more unstable patients (35 ± 3% of sessions with hypotension on HFR-Aeq versus 71 ± 3% on HFR, P <0.001). No clinical or biochemical signs of Na/water overload were registered during the treatment with HFR-Aeq.

Conclusions: HFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na(+) measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice.

Citing Articles

Low dialysate sodium levels for chronic haemodialysis.

Marshall M, Wang M, Vandal A, Dunlop J Cochrane Database Syst Rev. 2024; 11:CD011204.

PMID: 39498822 PMC: 11536490. DOI: 10.1002/14651858.CD011204.pub3.

Changes in serum sodium concentration during hemodialysis is a predictor of mortality and cardio-cerebrovascular event.

Liu Q, Zheng K, Wang H, Song D, Li X Ren Fail. 2024; 46(1):2338483.

PMID: 38604948 PMC: 11011235. DOI: 10.1080/0886022X.2024.2338483.

Technical requirements and devices available for long-term hemodialysis in children-mind the gap!.

Ranchin B, Peter Schmitt C, Warady B, Hataya H, Jones J, Lalji R Pediatr Nephrol. 2023; 39(9):2579-2591.

PMID: 38141144 DOI: 10.1007/s00467-023-06233-0.

Feedback control in hemodialysis.

Randhay A, Eldehni M, Selby N Semin Dial. 2023; 38(1):62-70.

PMID: 37994191 PMC: 11867153. DOI: 10.1111/sdi.13185.

Sodium First Approach, to Reset Our Mind for Improving Management of Sodium, Water, Volume and Pressure in Hemodialysis Patients, and to Reduce Cardiovascular Burden and Improve Outcomes.

Canaud B, Kooman J, Maierhofer A, Raimann J, Titze J, Kotanko P Front Nephrol. 2023; 2:935388.

PMID: 37675006 PMC: 10479686. DOI: 10.3389/fneph.2022.935388.

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