Flythe Jennifer E, Mc Causland Finnian R
Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) School of Medicine and UNC Kidney Center, Chapel Hill, North Carolina.
The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
Semin Dial. 2017 Mar;30(2):99-111. doi: 10.1111/sdi.12570. Epub 2017 Jan 8.
Oligo-anuric individuals receiving hemodialysis (HD) are dependent on the dialysis machine to regulate sodium and water balance. Interest in adjusting the dialysate sodium concentration to promote tolerance of the HD procedure dates back to the early years of dialysis therapy. Evolution of dialysis equipment technologies and clinical characteristics of the dialysis population have prompted clinicians to increase the dialysate sodium concentration over time. Higher dialysate sodium concentrations generally promote hemodynamic stabilization and reduce intradialytic symptoms but often do so at the expense of stimulating thirst and promoting volume expansion. The opposite may be true for lower dialysate sodium concentrations. Observational data suggest that the association between dialysate sodium and outcomes may differ by serum sodium levels, supporting the trend toward individualization of the dialysate sodium prescription. However, lack of randomized controlled clinical trial data, along with operational safety concerns related to individualized dialysate sodium prescriptions, have prevented expert consensus regarding the optimal approach to the dialysate sodium prescription.
接受血液透析（HD）的少尿或无尿患者依赖透析机来调节钠和水平衡。调整透析液钠浓度以提高对HD治疗耐受性的兴趣可追溯到透析治疗的早期。透析设备技术的发展以及透析人群的临床特征促使临床医生随着时间的推移提高透析液钠浓度。较高的透析液钠浓度通常可促进血流动力学稳定并减少透析期间的症状，但往往是以刺激口渴和促进容量扩张为代价。较低的透析液钠浓度可能情况相反。观察性数据表明，透析液钠与结局之间的关联可能因血清钠水平而异，这支持了透析液钠处方个体化的趋势。然而，缺乏随机对照临床试验数据，以及与个体化透析液钠处方相关的操作安全性问题，阻碍了就透析液钠处方的最佳方法达成专家共识。
