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Sodium removal and plasma tonicity balance are not different in hemodialysis and hemodiafiltration using high-flux membranes

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Abstract

Background

The clinical benefits of on-line hemodiafiltration (HDF) versus high-flux membranes hemodialysis (hf-HD) are still debated. In fact, although a superiority of one treatment over the other, especially in terms of mortality, did not emerge from the analysis of clinical trials, improved intradialytic vascular stability and cardiovascular mortality have been observed in patients undergoing HDF rather than hf-HD; the lower removal of sodium (Na+) during HDF seems to play a major role. The plasma concentration of Na+ is the major determinant of plasma tonicity, which, by determining the flow of water between the intracellular and the extracellular compartment, contributes to the vascular refilling process and the maintenance of blood pressure during the hemodialysis treatment. Plasma tonicity also depends on plasma glucose concentration, especially in patients with diabetes mellitus with hyperglycaemia at the start of hemodialysis treatment.

Materials and methods

We evaluated the removal of Na+ and plasma tonicity balance during a 2-week period by performing 2–3 consecutive sessions of hf-HD followed by 2–3 consecutive sessions of HDF, or vice versa, in 47 patients (40% diabetics) on chronic hemodialysis. Identical parameters were used in all dialytic sessions.

Results

Na+ removal per session was − 224 ± 144 mmol and − 219 ± 152 mmol, respectively, in hf-HD and in HDF (p = 0.79). The plasma tonicity balance per session was − 575 ± 310 mOsm and − 563 ± 328 mOsm, respectively, in hf-HD and in HDF (p = 0.75).

Conclusions

The removal of Na+ and plasma tonicity balance did not differ between hf-HD and HDF. This observation suggests that factors other than those assessed in our study might explain the improved cardiovascular stability reported in HDF.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, ASST Nord Milano, E. Bassini Hospital, Via Gorki 50, 20092, Cinisello Balsamo, MI, Italy

    Vincenzo La Milia, Elena Alberghini, Ivano Baragetti, Laura Buzzi, Francesca Ferrario, Silvia Furiani & Gaia Santagostino Barbone

  2. Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy

    Chiara Ravasi, Fabio Carfagna & Giuseppe Pontoriero

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  1. Vincenzo La Milia
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  2. Chiara Ravasi
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  3. Fabio Carfagna
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Correspondence to Vincenzo La Milia.

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La Milia, V., Ravasi, C., Carfagna, F. et al. Sodium removal and plasma tonicity balance are not different in hemodialysis and hemodiafiltration using high-flux membranes. J Nephrol 32, 461–469 (2019). https://doi.org/10.1007/s40620-018-00581-z

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