Dialysis unphysiology and sodium balance
Dialysis unphysiology was first discussed by Carl Kjellstrand in 1975 for the possible negative effects of the unphysiology of intermittent dialysis treatment. Current hemodialysis practices are still unphysiologic because they cannot keep blood chemistries within normal limits, both before and after dialysis. In addition, the discontinuous nature of hemodialysis causes saw-tooth volume fluctuations, and the extracellular fluid volume expansion during the interdialytic period may lead to hypertension and adverse cardiovascular consequences. Sodium, which is accumulated over the interdialytic period, may be divided into two fractions. The one is the fraction of osmotically active sodium which is mainly confined to the extracellular space, and the other is that of water-free (osmotically inactive) sodium which diffuses into the intracellular space. Both contribute to the pathogenesis of hypertension because the former may act to expand extracellular fluid volume and the latter may cause vasoconstriction in the long run by increasing cytosolic concentration of calcium in the vascular smooth muscle cells. Even in intensive hemodialysis, it may take several weeks to months for water-free sodium storage in the vascular smooth muscle cells to be relieved. This may be an explanation for the lag phenomenon, i.e., the delay of blood pressure decrease after normalization of extracellular fluid volume shown in the Tassin experience. Modest restriction of dietary sodium intake, the dialytic session length long enough to maintain a high ultrafiltration volume, and the reasonably low dialysate sodium concentration are required to avoid unphysiology of positive sodium balance in current hemodialysis practice.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2009 |
|---|---|
| Erschienen: |
2009 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:7 |
|---|---|
| Enthalten in: |
Electrolyte & blood pressure : E & BP - 7(2009), 2 vom: 20. Dez., Seite 31-7 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Kim, Gheun-Ho [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 14.07.2011 Date Revised 20.10.2021 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.5049/EBP.2009.7.2.31 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM207238367 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM207238367 | ||
| 003 | DE-627 | ||
| 005 | 20231224001643.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231224s2009 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.5049/EBP.2009.7.2.31 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0691.xml |
| 035 | |a (DE-627)NLM207238367 | ||
| 035 | |a (NLM)21468183 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Kim, Gheun-Ho |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Dialysis unphysiology and sodium balance |
| 264 | 1 | |c 2009 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 14.07.2011 | ||
| 500 | |a Date Revised 20.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Dialysis unphysiology was first discussed by Carl Kjellstrand in 1975 for the possible negative effects of the unphysiology of intermittent dialysis treatment. Current hemodialysis practices are still unphysiologic because they cannot keep blood chemistries within normal limits, both before and after dialysis. In addition, the discontinuous nature of hemodialysis causes saw-tooth volume fluctuations, and the extracellular fluid volume expansion during the interdialytic period may lead to hypertension and adverse cardiovascular consequences. Sodium, which is accumulated over the interdialytic period, may be divided into two fractions. The one is the fraction of osmotically active sodium which is mainly confined to the extracellular space, and the other is that of water-free (osmotically inactive) sodium which diffuses into the intracellular space. Both contribute to the pathogenesis of hypertension because the former may act to expand extracellular fluid volume and the latter may cause vasoconstriction in the long run by increasing cytosolic concentration of calcium in the vascular smooth muscle cells. Even in intensive hemodialysis, it may take several weeks to months for water-free sodium storage in the vascular smooth muscle cells to be relieved. This may be an explanation for the lag phenomenon, i.e., the delay of blood pressure decrease after normalization of extracellular fluid volume shown in the Tassin experience. Modest restriction of dietary sodium intake, the dialytic session length long enough to maintain a high ultrafiltration volume, and the reasonably low dialysate sodium concentration are required to avoid unphysiology of positive sodium balance in current hemodialysis practice | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a hypertension | |
| 650 | 4 | |a physiology | |
| 650 | 4 | |a renal dialysis | |
| 650 | 4 | |a sodium | |
| 773 | 0 | 8 | |i Enthalten in |t Electrolyte & blood pressure : E & BP |d 2006 |g 7(2009), 2 vom: 20. Dez., Seite 31-7 |w (DE-627)NLM207238294 |x 1738-5997 |7 nnns |
| 773 | 1 | 8 | |g volume:7 |g year:2009 |g number:2 |g day:20 |g month:12 |g pages:31-7 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.5049/EBP.2009.7.2.31 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 7 |j 2009 |e 2 |b 20 |c 12 |h 31-7 | ||