您将如何为您的患者开具透析液钠浓度处方?

F. Port
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引用次数: 1

摘要

在血液透析的早期,通常使用低钠透析液来增强扩散性钠去除,而不是通过超滤进行对流去除。然而,不平衡综合征很常见,尤其是当透析时间减少到4小时时。最近将DNa从最常见的140mEq/L水平降低的趋势与透析内低血压以及住院和死亡风险增加有关。较高的DNa也有缺点,如较高的血压和更大的分析间体重增加,可能是由于口渴加剧。我对证据的评估使我为大多数患者选择140水平的DNa,并避免DNa低于138。如果有透析症状的患者能够避免液体重量过度增加,那么他们可能会从DNa 142 mEq/L中受益。
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How Would You Prescribe the Dialysate Sodium Concentration for Your Patients?
Low sodium dialysate was commonly used in the early year of hemodialysis to enhance diffusive sodium removal beyond its convective removal by ultrafiltration. However, disequilibrium syndrome was common, particularly when dialysis sessions were reduced to 4 h. The recent trend of lowering the DNa from the most common level of 140 mEq/L has been associated with intradialytic hypotension and increased risk of hospitalization and mortality. Higher DNa also has disadvantages, such as higher blood pressure and greater interdialytic weight gain, likely due to increased thirst. My assessment of the evidence leads me to choose DNa at the 140 level for most patients and to avoid DNa below 138. Patients with intradialytic symptoms may benefit from DNa 142 mEq/L, if they can avoid excessive fluid weight gains.
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