Speaker: Ultrafiltration profiling should replace sodium profiling
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BOSTON — Although sodium profiling remains controversial in kidney care, a speaker at the National Kidney Foundation Spring Clinical Meetings cited resources that recommend replacing the practice with ultrafiltration profiling.
“What we found is that there's few studies nowadays that are suggesting that this [sodium profiling] is a good way of managing your patients on dialysis. So, it's controversial. Do you do this or do you not do this? The studies will show you that you should not be doing this,” Lisa Koester-Wiedemann, CNN-NP, ANP, CS, MSN, nephrology nurse practitioner at Washington University School of Medicine and member of Healio Nephrology News & Issues Editorial Advisory Board, said.
When looking at fluid management, Koester-Wiedemann suggested one looks at managing comorbid conditions. For example, when wondering what is causing a patient’s large intradialytic weight gains, consider if the patient has diabetes. Then, determine if the patient has good glycemic control and assess the patient’s diet.
Similarly, physicians could increase time and frequency of treatment. However, Koester-Wiedemann noted it is difficult to do this for various reasons. Therefore, she suggested that if physicians know patients with low residential renal function, they might consider prescribing patients for longer hours from the beginning.
Koester Wiedemann said, “The fact that we thought increasing dialysate sodium was a great tool to manage interdialytic weight gain ... Well, what have we learned?”
Koester-Wiedemann referenced studies between 1994 and 2006 that supported sodium profiling, but eventually researchers realized it was increasing the risk of mortality among patients, she said. Research revealed that stopping sodium “loading” led to less thirst between dialysis treatments, less fluid weight gain between treatments, lower ultrafiltration rates and more stable blood pressures.
“What we found out is you’re not going to use high-sodium profiling to manage your patients,” Koester-Wiedemann said. “What we have found is that it is not conducive to mortality in patients.”
Instead, ultrafiltration profiling is a better alternative, she said. Dialysis machines offer different ultrafiltration profiles, including profile one that provides high levels of ultrafiltration for almost half the treatment, then begins gradually decreasing until the end of the treatment; profile two that starts with aggressive ultrafiltration then gradually declines in removal; profile three that provides moderate ultrafiltration through two-thirds of the treatment and is followed by a dramatic decrease at the end of the treatment; and profile four that starts at a low ultrafiltration and moves into a series of decreasing peaks and valleys for the first two-thirds of the treatment.
“The tools we have are not utilizing sodium profiling anymore, managing sodium intake, controlling interdialytic hypertension, increasing time and frequency, and potentially using these profiles for your patients,” Koester-Wiedemann said.
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Koester-Wiedemann L. The benefits and drawbacks of sodium and UF profiling. Presented at: National Kidney Foundation Spring Clinical Meetings; April 5-10, 2022; Boston.
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