The effectiveness of this method was demonstrated in a multi-centre randomized controlled trial in which 39 haemodialysis patients prone to intradialytic hypotension were treated using both fixed dialysate conductivity and CP-690550 manufacturer a dialysate conductivity derived from the conductivity kinetic model. There was a significant reduction in the intradialytic fall in systolic blood pressure (BP) when patients were dialysed using the conductivity kinetic model, with a trend towards better cardiovascular stability. Current evidence suggests that sodium modelling should be considered in patients prone to

intradialytic hypotension and those troubled by disequilibrium symptoms. Ultrafiltration refers to removal of water and constituent solutes, which thereby reduces plasma and extracellular fluid volume. It is accepted practice to perform a period of isolated UF before dialysis to improve tolerance of fluid removal in an overloaded patient. There have been few studies examining modelled UF alone, as it is usually examined Selleckchem BGB324 in conjunction with sodium modelling. In

the aforementioned study by Zhou et al.,5 modelled UF with standard dialysate sodium resulted in a non-significant increase in intradialytic hypotensive episodes. Donauer et al.8 trialled 53 patients on 6 regimens of UF including constant, linear reduction, stepwise reduction and intermittent high UF rate interrupted by UF pauses, while simultaneously measuring MYO10 relative blood volume. Linear modelled UF was

associated with an apparent reduction in hypotensive episodes, but this was not statistically significant. Stepwise and intermittent high UF models were associated with a significant increase in the frequency of symptomatic hypotension. Poor compliance with fluid restriction necessitates a higher rate of UF, and thereby increased risk of intradialytic hypotension. The level of patient compliance with fluid restriction has not been documented in the aforementioned studies. The absence of this information further limits any interpretation and recommendations that arise from these studies. Based on this limited evidence, nonlinear UF modelling alone may not be tolerated by some patients, and is best avoided in those prone to intradialytic hypotension. There are limited data to support linear modelling of UF as a method of avoiding intradialytic hypotension. Potassium is central to cardiac pacemaker rhythmicity, neuromuscular excitability and maintenance of resting cell membrane potential. Both hypokalaemia and hyperkalaemia predispose to cardiac arrhythmias.9 A higher dialysate potassium concentration is recommended for patients on digitalis therapy. Hyperkalaemia in the dialysis population is independently associated with higher all-cause and cardiovascular mortality.9 Both the rapid fall in serum potassium early in dialysis and hypokalaemia late in dialysis are arrhythmogenic.