Abstract
While the side effects related to dialysis were markedly reduced by replacing acetate with bicarbonate in the dialyzing fluid, the replacement significantly increased water removal. Since the amount of the removed water may be correlated with the amount of sodium removed, complaints related to dialysis appear with the removal of excess sodium, along with the increase in water removed. In order to improve this situation and perform symptomless dialysis, removal of only an amount of sodium corresponding to dietary intake is important.
Consequently, preparation of a sodium concentration in the dialyzing solution for the removal of sodium, with the simultaneous removal of intracellular water, is necessary. By the use of an Na-infuser, prescription dialysis with adaptation of the Na concentration in the dialyzing solution according to the patient has become possible. By using a dialyzer with high performance and wide contact surface, more efficient asymptomatic dialysis may be performed. According to multiple regression analysis on 500 dialyses, the amount of removed water was found to be quite high for the determination of adequate Na concentration in the dialyzing solution. A simplified formula using the amount of removed water as the factor (DNa=3.3×UF+133) was proposed.
For prescription dialysis with bicarbonate, a concept of dietary control distinct from the conventional lowefficiency dialysis is necessary. Control of water and sodium intake to facilitate the prescription dialysis is imperative. Diets providing less than 6g of NaCl per 1l mean volume of water removal, based on the balance of water and NaCl intake, is desirable.
For the prescription of protein intake, it is necessary to evaluate protein intake and the performance of the dialyzer based on the amount of urea production. Urea production in calculated according to urea kinetics and laboratory data, and the protein intake estimated based on PCR of Gotch's formula and the amount of urea removed by dialysis. Additional calculations require BUN values before and after dialysis to maintain a balance between urea production and removal.
