高Na+透析の処方理論

概要

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Although high Na hemodialysis has several advantages over low Na or usual HD, the optimal Na concentration of dialysate must be different for each patient. We developed a biological model to estimate intracellular and extracellular fluid volume during HD using ICF and ECF before HD and dialysate Na concentration. Furthermore, we made another model to estimate ICF and ECF before HD using the sex of the patient, body build, dry weight, body weight and serum [Na] before HD. Combining these models, we can simulate ICF, ECF, and serum [Na] at any time during the treatment by HD. Therefore, the optimal dialysate Na concentration can be determined in individual patients, if serum [Na] at the end of HD is settled. Since serum [Na] is generally low and ICF is increased before HD, serum [Na] should be corrected around 145 mEq/l to normalize ICF by HD.<BR>The optimal dialysate Na concentration based on our models is approximately 150 mEq/l for Japanese men, however, should be variable by body fluid volume of the patient (body weight, sex, build), ultrafiltration rate, dialyser's clearance, serum [Na] before HD and the duration of HD. Now that Na infusers adjusting dialysate Na concentration to the optimal level have been available, prescription of high Na hemodialysis for individual patients becomes practically possible.
日本膜学会の論文