CIN '2007 - 4o CONGRESSO DE NEFROLOGIA NA INTERNET
The Sodium Concentration is too High in Maintenance Dialysis Today
Stanley Shaldon and Jörg Vienken
Monaco & Bad Homburg
Abstract
More than 40 years ago, we published our initial studies on the dramatic results that were obtainable using dietary salt restriction to treat hypertension in anuric patients with end-stage renal disease receiving maintenance hemodialysis. I had been schooled in the benefits of salt restriction when I had worked with Sheila Sherlock treating patients with cirrhosis and ascites. I was already familiar with Walter Kempner's original success with a rice diet in controlling hypertension in patients with chronic renal failure and also the success that Belding Scribner had achieved in Seattle with his original patients. As our results were so dramatic I have always preached the need for salt restriction in patients with chronic kidney disease. We were always impressed that the real benefit occurred several months after the patient had reached "dry body weight."Comments:
- El punto de la restricción en sal para los pacientes sigue siendo controvertido. En la actualidad un servidor ha trabajado con dieta sin restricciones en sal incluso en líquidos, he utilizado un sodio en dializante de 138meq, y ajusto el peso seco de forma continua, cada sesión, hasta conseguir la meta: el control de la presión arterial, sin retención de líquidos, sin sed. Educando e informando al paciente y explicandole la meta a conseguir durante su enfermedad y la asistencia a hemodiálisis.
Mejora la calidad de vida y el paciente debe ser responsable de no excederse.
Luis Antonio Bermudez Aceves
centro integral de nefrología hospital ángeles Santelena - México - This is interesting, I tried lowering dialysate sodium in some patients who have no itradialytic hypo episodes but many C/O cramps at the end of Dx sessions or post Dx.
Salwa Ibrahim
Cairo University - Egipto - In my experience, one cannot lower the dialysate sodium in patients who are not compliant to a 5g salt intaake pe day. Indeed I would not advise you to lower the dialysate sodium unless the patient is compliant.Compliance is best judged by interdialytic weight gain in the anuric patient. If this exceeds 1.5Kg for a 70Kg patient then the patient is eating more than 5g salt per day. Lowering the dialysate sodium below a nominal 140 sodium mmol/L (remebering that the error of measurement with the most accurate method is +/- 3% can be extremely dangerous in my experience as it will even result in death from an acute dysequilibrium syndrome with cerebral convulsions.
Stanley Shaldon
- Mónaco