Abstract
Sequential hypertonic dialysis (SHD) was studied in two binephrectomized children over a period of 6 weeks. Each dialysis session comprised four periods of 45 min. The concentration of sodium in the dialysate [Na(D)] during the first period was 190 mmol/l and during the second period 140 mmol/l. The sequence was then repeated. The sodium-free water clearance [C(ONa)] was calculated from the measurements of the ultrafiltrate clearance and of the sodium clearance. Despite the short periods of hypertonic dialysis, C(ONa) was positive, suggesting that water was removed from the intracellular compartment as well as from the extracellular fluid. The transfer of fluid from the intracellular space improved circulatory stability during rapid removal of large volumes of fluid by ultrafiltration. SHD was also associated with increased removal of potassium and phosphate. Comparison of clinical parameters before and during SHD showed a tendency towards increased sodium balance and the possibility of raised cardiovascular morbidity. SHD stabilized blood volume during ultrafiltration, encouraging removal of uraemic toxins. SHD with this levels of Na(D) is only a study dialysis method.
Similar content being viewed by others
References
Nevins TE, Kjellstrand CM (1983) Hemodialysis for children. A review. Int J Pediatr Nephrol 4:155–169
Martin Malo A, Perez R, Gomez J, Burdiel LG, Andres E, Castillo D, Moreno E, Aljana P (1985) Sequential hypertonic dialysis. Nephron 40:458–462
Waugh WH (1969) Utility of expressing serum sodium per unit of water in assessing hyponatremia. Metabolism 18:706–712
Funck-Brentano JL (1981) Sodium-free water clearance in hemodialysis. Artif Organs 5:51–53
Funck-Brentano JL, Man NK (1984) Optimization of Na content in dialysis fluid. Nephron 36:197–200
Gotch FA, Sargent JA (1983) Hemofiltration: an unnecessarily complex methods to achieve hypotonic sodium removal and controlled ultrafiltration. Blood Purif 1:9–15
Arieff AL, Massry SG, Barrientos A (1973) Brain water and electrolyte metabolism in uremia: effects of slow and rapid hemodialysis. Kidney Int 4:177–187
Rubin L, Gutman R (1978) Hypotension during hemodialysis. Kidney Int 13:21–24
Hagstam K, Leindergard B, Tibbling T (1969) Mannitol infusion in regular hemodialysis treatment for chronic renal insufficiency. Scand J Urol Nephrol 3:257–263
Aizaba Y, Hirasawa Y (1979) A fall of plasma osmolality created at dialyser and its possible effect on circulating blood volume. Clin Nephrol 12:269–272
Ewing D, Winney R (1975) Autonomic function in patients with chronic renal failure on intermittent hemodialysis. Nephron 15:424–429
Henrich WL, Katz F, Molinoff P, Schzier R (1977) Competitive effects of hypokaliemia and volume depletion on plasma renin activity, aldosterone and catecholamine concentration in hemodialysis patients. Kidney Int 12:279–284
Fischbach M, Hamel G, Meunier Carus J, Tarral E, Zita N, Geisert J (1986) Acetate hemodialysis in children: carbon dioxide removal with or without hypoxemia if a high permeable membrane is used. Nephron 42:185–186
Maggiore Q, Pizzarelli F, Zocalli C, Sisca S, Nicolo F, Parlongo S (1981) Effect of extracorporeal blood cooling in dialytic arterial hypotension. Proc Eur Dial Transplant Ass 18:597–601
Novello A, Kelsch R, Easterling R (1976) Acetate intolerance during hemodialysis. Clin Nephrol 5:29–32
Locatelli F, Ponti R, Pedrini L, Costanzo R, Di Fillippo S, Marai P (1984) Sodium kinetics across dialysis membranes. Nephron 38:174–177
Cybulsky AVE, Matni A, Hollonby DJ (1985) Effects of high sodium dialysate during maintenance hemodialysis. Nephron 41:57–61
Redrelli B (1979) Hemodialysis with adequate sodium concentration in dialysate. Artif Organs 2:133–140
Maeda K, Kawaguchi S, Kobayashi S, Niwa T, Kobayashi K, Saito A (1980) Cell wash dialysis. Trans Am Soc Artif Intern Organs 26:213–218
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fischbach, M., Tarral, E. & Geisert, J. Sequential hypertonic haemodialysis in children. Pediatr Nephrol 2, 442–446 (1988). https://doi.org/10.1007/BF00853439
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00853439