Sodium modeling has been utilized over the last two decades with a goal of allowing increased ultrafiltration with decreased symptoms.
This type of sodium modeling is termed "sodium neutral" modeling.
Table 1 Identification of Learning Needs Areas of Learning Knowledge Needs Needs Fluid shifts A) Understanding compartmental fluid shifts Hematocrit-based A) Understanding the physiological principles blood volume for hematocrit-based blood volume monitoring (for example, Crit-Line[R]) B) Proper utilization of hematocrit-based blood volume monitoring Sodium modeling
A) Understanding the physiological principles for sodium modeling
B) Proper utilization to assist in fluid removal
This article looks at the controversy over sodium modeling in dialysis and will provide a brief overview of the role of sodium in dialysis and then present each side of the sodium modeling debate.
Sodium modeling starts by using hypernatremic dialysate and during the treatment decreases to a hyponatremic dialysate that is thought to remove excess sodium that has been transferred to the patient during the hypernatremic period.
The purpose of sodium modeling has always been to reduce the incidence of adverse effects of dialysis, which include hypotension, nausea, vomiting, dialysis disequilibrium, and cramping.
Studies have shown that sodium modeling has been used successfully to reduce the incidence of adverse effects, particularly in patients who are prone to hypotension due to slow movement of fluid from the interstitial spaces or underlying cardiac and peripheral vascular disease (Song et al., 2002).
Oliver, Edwards, and Churchill (2001) showed that sodium modeling and ultrafiltration modeling could be used together to not only reduce the adverse effects of dialysis treatments, but also the adverse effects of sodium modeling.
Other interventions listed included administering oxygen, using sodium modeling, notifying the physician, monitoring or adjusting the dry weight, decreasing dialysate temperature, administering levocarnitine, and administering midodrine.
The most common interventions identified for the treatment of frequent episodes of IDH are dry weight adjustments, education on fluid intake, sodium modeling, ultrafiltration profiling, lower dialysate temperature, and extra dialysis treatment.
Table 4 Proactive Interventions to Manage IDH Episodes Number of Intervention responses Dry weight adjustments 331 Patient education on fluid intake 325 Sodium modeling 322 Ultrafiltration profiling 256 Lower dialysate temperature 182 Extra dialysis treatment for ultrafiltration only 179 Use of Crit lines 60 Other 17 None of the above 0 Note: Respondents could check more than one answer.
Intradialytic hypotension may be minimized by the use of sodium modeling
, midodrine administration, cool dialysate, or isolated ultrafiltration.