Applying sodium profile with or without ultrafiltration profile failed to show beneficial effects on the incidence of intra-dialytic hypotension in susceptible hemodialysis patients

Intra-dialytic hypotension [IDH] is a common complication during hemodialysis [HD] treatment. Previous studies have reported that modulating dialysate sodium concentration combined or not with modulation of ultrafiltration [UF] rate may reduce the incidence of IDH. The aim of the present study was to evaluate the effect of sodium and UF profiles on the occurrence of intra-dialytic complications and dialysis quality. From a total of 64 patients, we selected 18 patients who suffered from recurrent IDH. Every patient received ten HD sessions utilizing each of the following treatments: [1] Control: constant sodium concentration and UF rates. [2] Sodium and UF profiles: a linearly decreasing sodium concentration combined with a linearly decreasing UF rate. [3] Sodium profile:decreasing sodium concentration with constant UF rate. Fourteen patients completed the study protocol. The incidence of IDH, mean inter-dialytic weight gain and the delivered dialysis dose were not different between the three treatments. However, symptomatic episodes of IDH were more common and pre-dialysis systolic blood pressure was higher during the second and third treatment modalities compared to controls. Isolated sodium profile was associated with more malaise and less achievement of target session duration compared to the other two treatments. Isolated sodium profile was associated with less achievement of target UF while combined sodium and UF profiles were associated with more achievement of target UF compared to controls. Our results indicate that sodium profile with or without UF profile does not have a beneficial effect on the incidence of IDH, achievement of target session duration or the delivered dialysis dose

Acute renal failure following the Saharan horned viper [Cerastes cerastes] bite

The Saharan horned viper [Cerastes cerastes] is a common snake in the sandy and rocky regions in the south of Morocco. Although nearly all snakes with medical relevance can induce acute renal failure [ARF], it's unusual except with bites by some viper species. ARF has very rarely been reported following Cerastes cerastes bite. A 55-year-old Moroccan man was bitten on his right hand by a Saharan horned viper, Cerastes cerastes. He presented 24 hours later in a state of confusion, agitation and hypotension with marked swelling of his right hand. Investigations revealed evidence of disseminated intravascular coagulation [DIC] and rhabdomyolysis. The appropriate antivenom was not available. Despite adequate hydration, he developed acute renal failure necessitating prolonged hemodialysis. He subsequently improved and was discharged from the hospital after four weeks with normal renal function. Although uncommon, the bite of Cerastes cerastes can result in ARF due to DIC and rhabdomyolysis. The appropriate antivenom should be made available in areas where this snake is prevalent