Mechanisms By Which Acetate Buffer Contributes To Hemodynamic Instability

tonic levels by the end of the procedure. The concentration of sodium can be reduced in a linear, exponential, or step pattern. This method of sodium control allows for a diffusive sodium influx early in the session to prevent a rapid decline in plasma osmolality secondary to efflux of urea and other small-molecular weight solutes. During the remainder of the procedure, when the reduction in osmolality accompanying urea removal is less abrupt, the dialysate is sodium level is set lower, thus minimizing the development of hypertonicity and any resultant excessive thirst, fluid gain, and hypertension in the interdialysis period. In some but not all studies, sodi-i modeling has been shown to be effective in treating intradialysis hypotension-

Indications and contraindications for use of sodium modeling (high/low programs). Use of a sodium modeling program is not indicated in all patients. In fact most patients do well with the dialysate sodium set at 140 mEq/L. As a result the physician needs to be aware of the benefits as well as the dangers of sodium remodeling.

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