Concurrent Control of Sodium and Bicarbonate Serum Concentrations Using a Four-Stream Hemodialysis Fluid Delivery System

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2025-03-06 DOI:10.1111/hdi.13205

Deepak Malhotra, Susie Q. Lew, Raymond E. Garrett, Ramin Sam, Robert H. Glew, Todd S. Ing, Antonios H. Tzamaloukas

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引用次数: 0

Abstract

Background

Previously, two reports proposed a four-stream dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a sodium chloride concentrate, and product water for correcting dysnatremias and metabolic acid–base disorders separately, by hemodialysis.

Methods

This report describes a new method for the clinical use of the previously reported four-stream dialysis fluid delivery system to treat concurrently dysnatremias and metabolic acid–base disturbances by hemodialysis. Pumps attached to each concentrate are designed to control its flow rate. Formulas were derived to determine the flow rate of each of the pumps controlling the flows of the product water ( W ), the base concentrate ( B ), and the sodium chloride concentrate ( S ) for any prescribed combination of sodium and bicarbonate concentrations is the final dialysis fluid. In this scheme, the flow rate of the acid concentrate ( A ), the concentrations of its contents in the final dialysis fluid remain constant. The flow rate ratio W:S:B:A remains also constant at 45 (i.e., 45X).

Results

The formulas were entered in an EXCEL flow sheet which determines the flow rate ratio W:S:B:A for any desired combination of sodium and bicarbonate concentrations in the dialysis fluid. The upper and lower limits of the concentrations of sodium and bicarbonate in the dialysis fluid were computed. The system has not been applied clinically. Measurements of any electrolyte concentrations have not been made.

Discussion

This system makes the treatment of profound dysnatremias, metabolic acid–base disorders, and combined dysnatremias and metabolic acid–base disorders feasible. The clinical application of the system demands prior in vitro or ex vivo studies plus fastidious and expert attention to ensure safe and dependable application.

Abstract Image

查看原文本刊更多论文

使用四流血液透析液输送系统同时控制钠和碳酸氢盐血清浓度。

背景：此前有两篇报道提出了一种由酸浓缩物、碱浓缩物、氯化钠浓缩物和产品水组成的四流透析液体输送系统，通过血液透析分别用于纠正钠血症和代谢性酸碱紊乱。方法：本报告描述了一种新的方法，用于临床使用先前报道的四流透析液体输送系统治疗血液透析并发钠血症和代谢性酸碱紊乱。每个浓缩物的泵都是用来控制其流量的。导出公式以确定控制产品水(W)、碱浓缩物(B)和氯化钠浓缩物(S)流量的每个泵的流量，钠和碳酸氢盐浓度的任何规定组合是最终的透析液。在此方案中，酸浓缩液的流速(A)，其含量在最终透析液中的浓度保持不变。流量比W:S:B:A也保持45不变（即45X）。结果：将公式输入到EXCEL流程图中，该流程图确定透析液中钠和碳酸氢盐浓度的任何所需组合的流速比W:S:B:A。计算了透析液中钠和碳酸氢盐浓度的上限和下限。该系统尚未在临床上应用。没有对任何电解质浓度进行测量。讨论：该系统使深度钠代谢异常、代谢性酸碱紊乱以及钠代谢异常与代谢性酸碱紊乱合并治疗成为可能。该系统的临床应用需要事先进行体外或离体研究，加上严格的专家关注，以确保安全可靠的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.