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Individualized Sodium Management with the 6008 CAREsystem

Individualized Sodium Management with the 6008 CAREsystem allows for a diffusive sodium balance thanks to a closed-circuit control.

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One important goal in dialysis therapy is to keep interdialytic dietary salt intake and intradialytic sodium removal balanced. Sodium load during dialysis may lead to an increase in interdialytic weight gain and hypertension, both of which are major cardiovascular risk factors..

Patients’ predialysis serum sodium is widely spread1

The graph shows predialysis serum sodium for 369 unselected patients averaged over a period of 6 months (dialysate sodium 137 mmol / l, laboratory normal range for serum sodium concentration 135–145 mmol ⁄ l).

Currently, sodium concentration of the predialysis plasma is usually rarely determined individually. If the dialysate sodium should not follow a standard prescription, but should be aligned to the predialysis
plasma sodium, plasma sodium must be determined in the laboratory prior to each dialysis without Sodium Management.

The individual dialysate sodium prescription is the key factor to setting the sodium concentration gradient.

Acting on diffusive sodium mass transfer in terms of a reduced diffusive sodium load may lead to:

  • A reduction of thirst1 
  • A reduction of interdialytic weight gain2
  • A modification of short-term outcomes thanks to reduced fluid overload and reduced blood pressure3

Guidelines strongly recommend an individualized dialysate sodium4,5

Sodium loading during HD clearly results in greater thirst with resultant volume expansion, increased cardiac workload and subsequent hypertension.4
There is evidence to suggest that high dietary sodium intake and inadequate sodium removal during HD can result in excess fluid intake and hypertension.
Individualizing dialysate sodium to the plasma sodium concentration may improve hemodynamic stability during dialysis.5

The 6008 CAREsystem Sodium Management facilitates individualized dialysate sodium prescription management in order to better meet guideline recommendations. The individualized Sodium Management helps to avoid sodium load during dialysis

 

Easy alignment of dialysate sodium with plasma sodium concentration

Continuous measurements of dialysate conductivity determine the amount of diffusive sodium supplied to or removed from the patient. The device continuously measures the conductivity of the incoming and outgoing dialysate and determines the sodium balance using a kinetic model. Sodium Control (Na-control) automatically adapts the dialysate sodium to the plasma sodium of the patient. It individualizes the sodium prescription, helping to avoid additional costs and workload, can make extra time-consuming blood samples obsolete and is easily implemented in clinical practice

Principle of continuous balancing of diffusive sodium transfer with individualized Sodium Management

Information about patients’ salt intake enhances nutritional education

Salt intake during the interdialytic period is dependent on patient behavior and is a strong driver of volume overload.7 Visualization of patients’ sodium removal with Sodium Management provides information about interdialytic salt intake, enhances nutritional education and may improve HD patient outcomes.

Combining Sodium Management and BCM-based assessment of fluid status lays the path for precise and personalized sodium and fluid management and may improve hemodialysis patient outcomes.

 

The trend of predialysis plasma sodium may indicate pathologic changes

The monitoring of predialysis plasma sodium trend data (supported by a TDMS – Therapy Data Management System**) could indicate potential pathologic changes over time.

This information may be clinically used as a trigger for further considerations in case of deviations from the normal range, or for monitoring short- and mid-term trends for potential indication of pathological changes.8

**Therapy Data Management System is an umbrella term for different products, which are optional and must be purchased separately

 

Benefits of the easy and individualized Sodium Management with the 6008 CAREsystem

  • Controlling diffusive sodium transfer allows for an individualized sodium prescription.
  • Visualization of patients’ sodium removal for every treatment provides valuable information about their interdialytic salt intake.
  • Trend analysis via optional data management** of predialysis plasma sodium may help to indicate pathologic changes.

Distribution of plasma sodium changes

Graph adapted from reference9

Graph: Zero sodium diffusion narrows the distribution of plasma sodium changes.9

Frequency distribution of intradialytic plasma sodium changes when dialyzing 30 patients either with a standard fixed dialysate sodium of 138 mmol/l (light blue) or with Sodium Management and a target of zero diffusive transfer (dark blue)

Graph adapted from reference9

Sodium Management video

 

Sodium Management — a therapy feature available with the 6008 CAREsystem

Prof. Bernard Canaud
Emeritus Professor of Nephrology | Montpellier University, France
Chief Medical Scientist | Global Medical Office EMEA

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