Dialysate Composition in Hemodialysis and Peritoneal Dialysis






The goal of dialysis for patients with chronic renal failure is to restore the composition of the body’s fluid environment toward normal. This is accomplished principally by formulating a dialysate whose constituent concentrations are set to approximate normal values in the body. Over time, by diffusional transfer along favorable concentration gradients, the concentrations of solutes that were initially increased or decreased tend to be corrected. When an abnormal electrolyte concentration poses immediate danger, the dialysate concentration of that electrolyte can be set at a nonphysiologic
level to achieve a more rapid correction. On a more chronic basis the composition of the dialysate can be individually adjusted in order to meet the specific needs of each patient.

Dialysate Composition for Hemodialysis

In the early days of hemodialysis, the dialysate sodium concentration was deliberately set low to avoid problems of chronic volume overload such as hypertension and heart failure. As volume removal became more rapid because of shorter dialysis times, symptomatic hypotension emerged as a common and often disabling problem during dialysis. It soon became apparent that changes in the serum sodium concentration—and more specifically changes in serum osmolality— were contributing to the development of this hemodynamic instability.


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