Dialysate Sodium and the Milieu Intérieur

[摘要] The life-sustaining technology of maintenance hemodialysis attempts to accomplish in a dozen or so hours a week what the kidneys labor to do 24 hours per day: maintain the optimal composition and volume of body fluids. Claude Bernard's insight in the 1800s about the milieu intérieur (“all of the vital mechanisms, however varied they may be, have always one goal, to maintain the uniformity of the conditions of life in the internal environment”) (1) are not easily achieved by an intermittent therapy, particularly for sodium and fluid balance, which normal kidneys regulate constantly. As reviewed by Flanigan, in the early days of hemodialysis, patients were mostly dialyzed twice per week for >8 hours per session with very high glucose dialysate solutions to remove excess water via the creation of an osmotic gradient (2). A lower dialysate sodium (DNa) concentration was used, typically in the range of 125–130 mEq/L (3), to facilitate sodium removal by diffusion.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome