Individualized Sodium Management with the 6008 CAREsystem
Individualized Sodium Management with the 6008 CAREsystem allows for a diffusive sodium balance thanks to a closed-circuit control.
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One important goal in dialysis therapy is to keep interdialytic dietary salt intake and intradialytic sodium removal balanced. Sodium load during dialysis may lead to an increase in interdialytic weight gain and hypertension, both of which are major cardiovascular risk factors.
Patients’ predialysis serum sodium is widely spread1
The graph shows predialysis serum sodium for 369 unselected patients averaged over a period of 6 months (dialysate sodium 137 mmol / l, laboratory normal range for serum sodium concentration 135–145 mmol ⁄ l).
Currently, sodium concentration of the predialysis plasma is usually rarely determined individually. If the dialysate sodium should not follow a standard prescription, but should be aligned to the predialysis
plasma sodium, plasma sodium must be determined in the laboratory prior to each dialysis without Sodium Management.
The individual dialysate sodium prescription is the key factor to setting the sodium concentration gradient.
Acting on diffusive sodium mass transfer in terms of a reduced diffusive sodium load may lead to:
- A reduction of thirst1
- A reduction of interdialytic weight gain2
- A modification of short-term outcomes thanks to reduced fluid overload and reduced blood pressure3
Guidelines strongly recommend an individualized dialysate sodium4,5
Sodium loading during HD clearly results in greater thirst with resultant volume expansion, increased cardiac workload and subsequent hypertension.4
There is evidence to suggest that high dietary sodium intake and inadequate sodium removal during HD can result in excess fluid intake and hypertension.
Individualizing dialysate sodium to the plasma sodium concentration may improve hemodynamic stability during dialysis.5
The 6008 CAREsystem Sodium Management facilitates individualized dialysate sodium prescription management in order to better meet guideline recommendations. The individualized Sodium Management helps to avoid sodium load during dialysis
Easy alignment of dialysate sodium with plasma sodium concentration
Continuous measurements of dialysate conductivity determine the amount of diffusive sodium supplied to or removed from the patient. The device continuously measures the conductivity of the incoming and outgoing dialysate and determines the sodium balance using a kinetic model. Sodium Control (Na-control) automatically adapts the dialysate sodium to the plasma sodium of the patient. It individualizes the sodium prescription, helping to avoid additional costs and workload, can make extra time-consuming blood samples obsolete and is easily implemented in clinical practice.
Principle of continuous balancing of diffusive sodium transfer with individualized Sodium Management
Information about patients’ salt intake enhances nutritional education
Salt intake during the interdialytic period is dependent on patient behavior and is a strong driver of volume overload.7 Visualization of patients’ sodium removal with Sodium Management provides information about interdialytic salt intake, enhances nutritional education and may improve HD patient outcomes.
Combining Sodium Management and BCM-based assessment of fluid status lays the path for precise and personalized sodium and fluid management and may improve hemodialysis patient outcomes.
The trend of predialysis plasma sodium may indicate pathologic changes
The monitoring of predialysis plasma sodium trend data (supported by a TDMS – Therapy Data Management System**) could indicate potential pathologic changes over time.
This information may be clinically used as a trigger for further considerations in case of deviations from the normal range, or for monitoring short- and mid-term trends for potential indication of pathological changes.8
**Therapy Data Management System is an umbrella term for different products, which are optional and must be purchased separately
Benefits of the easy and individualized Sodium Management with the 6008 CAREsystem
- Controlling diffusive sodium transfer allows for an individualized sodium prescription.
- Visualization of patients’ sodium removal for every treatment provides valuable information about their interdialytic salt intake.
- Trend analysis via optional data management** of predialysis plasma sodium may help to indicate pathologic changes.
Distribution of plasma sodium changes
Graph: Zero sodium diffusion narrows the distribution of plasma sodium changes.9
Frequency distribution of intradialytic plasma sodium changes when dialyzing 30 patients either with a standard fixed dialysate sodium of 138 mmol/l (light blue) or with Sodium Management and a target of zero diffusive transfer (dark blue).
Sodium Management video
Sodium Management — a therapy feature available with the 6008 CAREsystem
Prof. Bernard Canaud
Emeritus Professor of Nephrology | Montpellier University, France
Chief Medical Scientist | Global Medical Office EMEA
Sodium management symposium videos
56th ERA-EDTA Congress 2019
Present and future of sodium and water handling to improve outcomes in ESKD patients
Three experts presented different aspects of fluid management in hemodialysis therapies at the sodium management symposium (ERA-EDTA Congress 2019).
Watch the symposium videos
1.Lindley EJ, Reducing sodium intake in hemodialysis patients. Semin Dial. 2009 May-Jun;22(3):260-263.
2. Raimann JG, Thijssen S, Usvyat LA, et al., Sodium alignment in clinical practiceimplementation and implications. Semin Dial. 2011;24:587–592.
3. Sagova et al., Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis. Artif Organs. 2019 Oct; 43(10):1002-1013.
4. National Kidney Foundation, KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930.
5. Kooman et al., EBPG guideline on haemodynamic instability Nephrol Dial Transplant 2007; 22 [Suppl 2]:ii22-ii44.
6. Canaud B et al., Sodium and water handling during hemodialysis: new pathophysiologic insights and management approaches for improving outcomes in end-stage kidney disease. Kidney International 2019;95:304.
7. Basile C, and Lomonte C., A neglected issue in dialysis practice: haemodialysate. Clin Kidney J. 2015;8:393–399.
8. Maierhofer A et al., EDTA-Poster 2019 FP546, “Conductivity based online estimation of predialytic plasma Na: clinical assessment”. https://academic.oup.com/ndt/article/34/Supplement_1/gfz106.FP546/5515421
9. Canaud et al., Kidney International (2019) 95, 296-309.