Advice on sodium profiles (hemo)

[RightSide]

I do in-center hemo 3x/week.

Those damn sodium profiles make me terribly thirsty (combined with the fact that the techs sometimes take off more fluid than they're supposed to).  Imagine, putting salt into the body of a dialysis patient who's already on fluid restriction.  Great.

I don't see why I need a sodium profile anyway, because I rarely put on much fluid.  (Typically I come in just 1 kilo over my dry weight.)

What do you folks do about those sodium profiles?  Do you refuse them?  Or is one type of profile easier to take than another?

[aharris2]

Yes, my brother refuses them. In fact, he had to fight that battle (once again) today. If they use a sodium profile on him, he is so thirsty afterwards that he is fluid overloaded by (or before) the next treatment.

[tyefly]

what is a sodium profile

[circleNthedrain]

I never used a sodium profile until a new tech suggested I try it to remove more fluid.  OMG!  I was so thirsty the next day.  Never again!

[caringpct]

As a tech I use a sodium profile on my patients that have issues with low blood pressure. I stop the profile about 30 minutes before the end of treatment so that their body can get back into a balance. There are 2 main profiles I use and that is a step or linear. The step gives more sodium all at once and the linear slowly decreases throughout the treatment. Sometimes if my patients tell me that they are thirsty the next day, I use a uf profile instead. There are several of these that take off fluid. If you don't like the sodium then refuse it, that is your patient right.

[KICKSTART]

Sodium profile? Never heard of them ..dont even think we have them over here !

[galvo]

Likewise.

[Bub]

Interesting.  I ask about my sodium profile, and everyone at my center was aware of the term but nobody could give me any information.  I was referred to my neph (who I dont ever recall meeting).

[Hemodoc]

Sodium profiles do add salt to the dialysis patient which is what drives the thirst right after dialysis in many patients treated with this.  For a patient that only gains one kg between sessions, it is certainly reasonable to question your nephrologist why you are being treated with a sodium profile which is usually reserved for patients with unstable blood pressures during dialysis.  However, since even these patients are given a salt load, it sets up a cycle of large interdialytic weight gains followed by high ultrafiltration rates that then leads to more hypotensive episodes during dialysis.  Many recommend against sodium profiles because of the salt load and side effects associated with the salt load.

Bottom line, patients are allowed to refuse treatments.  Technically, they must give you an informed consent on any procedure that they do.  You will need to discuss your issues with the RN on duty as well as with your nephrologist focussing on the fact that you are having thirst after your dialysis as well as excellent interdialytic weight gains that may actually improve if you are not subject to the sodium load given during sodium profiling.

Dr John Agar has an excellent article on plasma refill rates and solutes that gives the physiology associated with low blood pressure due to high ultrafiltration rates.  The plasma refill rates is usually lower than most dialysis patients ultrafiltration rate setting up the low blood pressures that sodium profiling tries to prevent. 

http://www.homedialysis.org/files/pdf/resources/tom/200712.pdf

It is quite possible that your tech simply sets up a sodium profile for you since she does it for many other patients without any real thought about your individual situation.  I personally believe that we should not use sodium profiling and instead use longer, and slower and gentler dialysis instead taking note of the dynamics between the plasma refill rate and the ultrafiltration rate.  That is really the heart of the matter as you can see when reading Dr. Agar's article.  If you are not having any low blood pressure episodes, then I am amiss on why they are even using a sodium profile in your case from what you have told about the situation.

So, once again, patients do have to consent to all treatments and you are most certainly allowed to question why they are doing the sodium profile in the first place.  An educated patient can absolutely contribute effectively to their own care.

Good luck speaking about these issues with your health care team and I hope you are able to resolve this issue with them.