The Effect of Gradient Ultrafiltration and High Sodium Dialysate on Reducing Complications During Hemodialysis / 대한신장학회잡지

OBJECTIVE: The objective of this study was to determine whether complications and nursing interventions during hemodialysis could be reduced by using gradient ultrafiltration(GUF) and high sodium dialysate(HSD). METHODS: Thirty outpatients who had been on hemodialysis for more than 3 months were enrolled. Patients received Conventional HD(Na+ 137 mEqX4 hrs, constant UF), GUF(UF 62.5%X2 hrs, UF 37.5 %X2 hrs), HSD(Na+ 145 mEqX2 hrs, Na+ 140 mEqX2 hrs) and HSUF(GUF and HSD). Each methods were prescribed for 2 weeks. The clinical features such as thirst, interdialytic weight gain, postdialytic weight loss and MAP(mean arterial pressure) and the frequency of intradialytic complications and nursing interventions were evaluated. RESULTS: The results were as followings. Interdialytic thirst, weight gain, postdialytic weight loss and MAP(pre/post HD) were not significantly different in each method. On the other hand, there was significant difference between 4 methods in serum sodium, osmolality and Hct. There were significantly fewer episodes of hypotention, muscle cramp and headache when using GUF, HSD and HSUF than CHD. The number of nursing interventions was significantly reduced in GUF, HSD and HSUF than CHD. CONCLUSION: Hemodialysis with gradient ultrafiltration and high sodium dialysate leads fewer complications and nursing interventions, more patient's well being.

The Effect of High Sodium Dialysate(HSD) on Blood Pressure in Hemodilaysis / 대한신장학회잡지

Hypotensive episode is one of the serious complication during hemodialysis. HSD has used for relief of this problem, but sometimes increased interdialytic weight gain or exacerbation of hypotension are happened. To evaluate the effect of HSD, 7 non- diabetic normotensive uremic patients were hemodialyzed with different sodium level of dialysate (stage A : Na 138mEq/L for 4hrs, stage B : Na 148mEq/L for 4hrs, stage C : initially Na 148mEq/L for 3hrs and Na 138mEq/L for 1hrs), and each stages were continued for 2 weeks. Ultrafiltration was performed to maintain the patient's estimated dry weight constantly. Interdialytic weight gain(stage A : 2.9+/-1.2kg, stage B : 3.2+/-1.1kg, stage C : 3.1+/-0.8kg) and presystolic systolic and diastolic blood pressure were not different in each stage. The incidence of hypotension (systolic BP<90mmHg) during hemodialysis was significantly lower in stage B and stage C(24%, 21%) than stage A(54%)(P<0.01). During hemodialysis the incidence of thirst was higher in stage B(40%) than stage A and stage C(11%, 12%) (P<0.05) significantly but there are no difference in headache and itching during hemodialysis between the each stage. Pre-dialysis and post-dialysis serum sodium and osmolality were not different in each stage but at 2 hrs after initiation of hemodialysis serum sodium and osmolality were higher in stage B(145.6+/-2.1mEq/L, 306+/-6.7mOsm/kg) and stage C (146.1+/-2.1mEq/L, 306+/-13.1mOsm/kg) than stage A (140.1+/-2.5mEq/L, 292+/-8.7mOsm/kg)(P<0.05). The ANP levels of pre-dialysis and post-dialysis were not different in each stage. In conclusion, HSD improved hypotenive episode. In spite of sodium load, increased interdialytic weight gain and elevation of pre-dialysis blood pressure were not developed and sodium modeling during hemodialysis attenuate some adverse effect of HSD.