Sodium modeling starting tomorrow - what should I watch out for?

[cattlekid]

Hello everyone!

I've been having some trouble the last couple of weeks with low BP and nausea at the very end of my treatments.  It got somewhat better when I was given the permission to bring in some water and a protein bar to eat but now the low BP is back - it was getting as low as 90/30 and the staff is having a hard time getting it back up even after returning my blood and giving saline.

At the end of yesterday's treatment, the nurse told my tech that she wants to start sodium modeling with tomorrow's treatment.  I've been doing a little reading on this site and others and see that there are some benefits and drawbacks to sodium modeling.  I definitely want to do everything I can to be able to tolerate a full treatment and not have to drag myself home afterwards.  However, I do see the drawbacks as well.   

Anyone been through sodium modeling?  Anything I should be watching out for? 

Thanks!!!   

[PatDowns]

How much fluid to do usually have to remove with treatment?   What is your treatment run time and blood pump speed?

[jbeany]

They didn't change mine much, but they accidentally left it set much higher once.  I left very, very thirsty!  Not a good thing for someone on fluid restrictions, so be careful of going overboard with fluid.

[Rerun]

It may help you.  They have various models.  Ask which one you are going to try first and keep track of which ones help and which ones don't.  They SHOULD keep track for you, but do it yourself if you want it done right.

[Sax-O-Trix]

What is "sodium modeling"?

[jbeany]

A setting on the D machine to adjust how much sodium is added during treatment.  If you have low bp, it can help stabilize it during the run so you don't crash and have to have too much saline dumped back on you.

[greg10]

..
At the end of yesterday's treatment, the nurse told my tech that she wants to start sodium modeling with tomorrow's treatment.  I've been doing a little reading on this site and others and see that there are some benefits and drawbacks to sodium modeling.  I definitely want to do everything I can to be able to tolerate a full treatment and not have to drag myself home afterwards.  However, I do see the drawbacks as well...

You can read a big long article about sodium modeling with HD, usually under the heading SVS (sodium variation system), but perhaps all you need to know is the last sentence after all that discussion, which I quote:
"SVS should always be balance neutral and may not be necessary with longer or more frequent treatments. "

In my opinion this is such a hack in order to justify doing short thrice weekly dialysis without causing intradialytic hypotension.  If you must do thrice weekly short treatments, especially with high fluid removal (ultrafiltration), then I suppose you should explore this.  Make sure your nurse understand that the sodium modeling should be sodium balance neutral and in a stepped decreasing profile, that is, high dialysate sodium concentrations at the beginning of the treatment and stepped down during the course of the treatment:

"Post dialysis hypotension and early intradialysis hypotension were best attenuated by decreasing, stepped profiles,"

[cattlekid]

Hello Pat!

On average, I usually have 3 L's removed for each treatment.  My run time is 3.75 hours.  Blood pump speed is 400. 

How much fluid to do usually have to remove with treatment?   What is your treatment run time and blood pump speed?

[cattlekid]

Thanks Rerun!  I'll make sure to ask.

It may help you.  They have various models.  Ask which one you are going to try first and keep track of which ones help and which ones don't.  They SHOULD keep track for you, but do it yourself if you want it done right.

[cattlekid]

Thanks greg!  I actually read this article earlier today which led me to post this LOL 

I am sticking with 3x per week in-center HD right now because I just got officially listed for transplant and have four live donors currently going through testing.  If all of my current potential live donors wash out, then I may start investigating other options.

You can read a big long article about sodium modeling with HD, usually under the heading SVS (sodium variation system), but perhaps all you need to know is the last sentence after all that discussion, which I quote:
"SVS should always be balance neutral and may not be necessary with longer or more frequent treatments. "

In my opinion this is such a hack in order to justify doing short thrice weekly dialysis without causing intradialytic hypotension.  If you must do thrice weekly short treatments, especially with high fluid removal (ultrafiltration), then I suppose you should explore this.  Make sure your nurse understand that the sodium modeling should be sodium balance neutral and in a stepped decreasing profile, that is, high dialysate sodium concentrations at the beginning of the treatment and stepped down during the course of the treatment:

"Post dialysis hypotension and early intradialysis hypotension were best attenuated by decreasing, stepped profiles,"

[PatDowns]

BP dropping out and nausea (plus, I'm sure washed out feeling and headache post treatment) are signs that your body is reacting to the large fluid and chemical shifts within such a short period of time.  Before going to sodium modeling, I would suggest asking your nephrologist to up your run time 30 minutes, lower the blood pump a bit to 350 and for you to start coming in with less fluid (<2.3L) to remove. 

No matter what the "optimal dialysis advocates" on here say, at this point in time in center patients are going to have to work within certain constraints mandated by providers.  One of those is shorter dialysis runs.  It is going to be up to you to do as well as possible under those limitations until receiving a transplant.  Watching your diet and fluid restrictions, following medication regimen (including binders), running the maximum time allowed under your facility guidelines for a day shift patient (4.15-4.30 hours should be doable) and running a pump speed that doesn't overly stress your heart should be your goals. 

I wish you the best and hope all four of the live donors will be compatible! 

Hello Pat!

On average, I usually have 3 L's removed for each treatment.  My run time is 3.75 hours.  Blood pump speed is 400. 

How much fluid to do usually have to remove with treatment?   What is your treatment run time and blood pump speed?

[Zach]

You may also try lowering your dialysate temperature to say 35.5 C.

 

[PatDowns]

Here's a research article backing Zach's suggestion.

http://ndt.oxfordjournals.org/content/19/1/190.full.pdf

You may also try lowering your dialysate temperature to say 35.5 C.

 

[boswife]

Was just reading and 'trying' to understand the "cool dialysate" process.  Soooooo, if we're using pureflo, what would that setting be?  And am i reading right that it is indeed a good thing to do?  Bo, hubby, hates to be cold so we have it rather high, but have lowered to the 15 as of these last couple of runs.(got an alarm 50..Dialysate too warm!!!! )    Have no idea though what each number stands for.... 

[kitkatz]

I use sodium profiling every dialysis treatment, otherwise I will cramp in the middle of it all.