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Dialyse aktuell 2019; 23(09): 411-415
DOI: 10.1055/a-0982-8647
Schwerpunkt | Dialyse
© Georg Thieme Verlag Stuttgart · New York

Salz- und Wasser-Zufuhr bei Dialysepatienten

Das Salz in der Suppe
Markus Mohaupt
1   Medizinische Klinik, Weiterbildungsklinik Innere Medizin Lindenhofgruppe und Universität Bern (Schweiz)
2   Division of Child Health, Obstetrics & Gynaecology, School of Medicine, City Hospital Campus, University of Nottingham (England)
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Publication History

Publication Date:
20 November 2019 (online)

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ZUSAMMENFASSUNG

Die Regulation von Na+ und Aldosteron ist komplex und eng mit dem Renin-Angiotensin-II-Aldosteron-System (RAAS) verknüpft. Die Aldosteron-Renin-Relation wird in physiologischen und pathophysiologischen Situationen, z. B. durch eine Hämodialysebehandlung, entkoppelt. Zudem ist die Angiotensin-I-Aktivierung durch das Angiontensin I Converting Enzyme (ACE) gesteigert. Komplizierend ist Na+ mit unterschiedlichen Wirkungen kompartimentalisiert: extrazellulär volumenwirksam, ossär zum langsamen Austausch gespeichert und wasserfrei im Gewebe tonizitätsassoziiert metabolisch aktiv. Eine spezifisch Na+-arme Diät ist nicht sinnvoll, da sie mit einer höheren Mortalität assoziiert ist. Jedoch scheint bei sonst gutem Ernährungszustand eine Kochsalz-Zufuhr von unter 6–7 g/d und eine geringe interdialytische Gewichtszunahme vorteilhaft für das Überleben zu sein. Studien zum Dialysat-Na+ sind von mäßiger Qualität und zeigen, dass ein tieferes Dialysat-Na+ zu einer geringeren interdialytischen Gewichtszunahme, zu einem niedrigeren prädialytischen Blutdruck und zu einem reduzierten Einsatz von Antihypertensiva führt. Krämpfe und intradialytische Blutdruckabfälle nehmen zu. Einige potenzielle Forschungsfragestellungen werden beschrieben.

 

  • Literatur

  • 1 Carlstrom M, Wilcox CS, Arendshorst WJ. Renal autoregulation in health and disease. Physiol Rev 2015; 95: 405-511 doi:10.1152/physrev.00042.2012
    CrossrefPubMedGoogle Scholar
  • 2 Gennari-Moser C, Khankin EV, Escher G. et al. Vascular endothelial growth factor-A and aldosterone: relevance to normal pregnancy and preeclampsia. Hypertension 2013; 61: 1111-1117 doi:10.1161/HYPERTENSIONAHA.111.00575
    CrossrefPubMedGoogle Scholar
  • 3 Eisele N, Klossner R, Escher G. et al. Physiological and Molecular Responses to Altered Sodium Intake in Rat Pregnancy. J Am Heart Assoc 2018; 7: e008363 doi:10.1161/JAHA.117.008363
    PubMedGoogle Scholar
  • 4 Duley L, Henderson-Smart D, Meher S. Altered dietary salt for preventing pre-eclampsia, and its complications. Cochrane Database Syst Rev 2005; 4: CD005548 doi:10.1002/14651858.CD005548
    Google Scholar
  • 5 Patel R, Ansari A. Serum angiotensin converting enzyme activity in patients with chronic renal failure on long term hemodialysis. Clin Chim Acta 1979; 92: 491-495 doi:10.1016/0009-8981(79)90232-8
    CrossrefPubMedGoogle Scholar
  • 6 Letizia C, Mazzaferro S, Morabito S. et al. Response of serum angiotensin converting enzyme, plasma renin activity and plasma aldosterone to conventional dialysis in patients on chronic haemodialysis. Int Urol Nephrol 1995; 27: 465-470 doi:10.1007/bf02550085
    CrossrefPubMedGoogle Scholar
  • 7 Iitake K, Kimura T, Matsui K. et al. Effect of haemodialysis on plasma ADH levels, plasma renin activity and plasma aldosterone levels in patients with end-stage renal disease. Acta Endocrinol (Copenh) 1985; 110: 207-213 doi:10.1530/acta.0.1100207
    PubMedGoogle Scholar
  • 8 Van Stone JC, Bauer J, Carey J. The effect of dialysate sodium concentration on body fluid compartment volume, plasma renin activity and plasma aldosterone concentration in chronic hemodialysis patients. Am J Kidney Dis 1982; 2: 58-64 doi:10.1016/s0272-6386(82)80044-9
    CrossrefPubMedGoogle Scholar
  • 9 Machnik A, Neuhofer W, Jantsch J. et al. Macrophages regulate salt-dependent volume and blood pressure by a vascular endothelial growth factor-C-dependent buffering mechanism. Nat Med 2009; 15: 545-552 doi:10.1038/nm.1960
    CrossrefPubMedGoogle Scholar
  • 10 Ponte B, Pruijm M, Ackermann D. et al. Copeptin Is Associated with Kidney Length, Renal Function, and Prevalence of Simple Cysts in a Population-Based Study. J Am Soc Nephrol 2015; 26: 1415-1425 doi: 10.1681/ASN.2014030260
    CrossrefPubMedGoogle Scholar
  • 11 O’Donnell M, Mente A, Rangarajan S. et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med 2014; 371: 612-623 doi:10.1056/NEJMoa1311889
    CrossrefPubMedGoogle Scholar
  • 12 Titze J. A different view on sodium balance. Curr Opin Nephrol Hypertens 2015; 24: 14-20 doi:10.1097/MNH.0000000000000085
    CrossrefPubMedGoogle Scholar
  • 13 Scaife PJ, Mohaupt MG. Salt, aldosterone and extrarenal Na+ – sensitive responses in pregnancy. Placenta 2017; 56: 53-58 doi:10.1016/j.placenta.2017.01.100
    CrossrefPubMedGoogle Scholar
  • 14 Canaud B, Kooman J, Selby NM. et al. Sodium and water handling during hemodialysis: new pathophysiologic insights and management approaches for improving outcomes in end-stage kidney disease. Kidney Int 2019; 95: 296-309 doi:10.1016/j.kint.2018.09.024
    CrossrefPubMedGoogle Scholar
  • 15 Tsuruya K, Fukuma S, Wakita T. et al. Dietary patterns and clinical outcomes in hemodialysis patients in Japan: a cohort study. PLoS One 2015; 10: e0116677 doi:10.1371/journal.pone.0116677
    CrossrefPubMedGoogle Scholar
  • 16 Kelly JT, Palmer SC, Wai SN. et al. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies. Clin J Am Soc Nephrol 2017; 12: 272-279 doi:10.2215/CJN.06190616
    CrossrefPubMedGoogle Scholar
  • 17 Ikenoue T, Koike K, Fukuma S. et al. Salt Intake and All-Cause Mortality in Hemodialysis Patients. Am J Nephrol 2018; 48: 87-95 doi:10.1159/000492034
    CrossrefPubMedGoogle Scholar
  • 18 Mc Causland FR, Waikar SS, Brunelli SM. Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients. Kidney Int 2012; 82: 204-211 doi:10.1038/ki.2012.42
    CrossrefPubMedGoogle Scholar
  • 19 Kalantar-Zadeh K, Tortorici AR, Chen JL. et al. Dietary restrictions in dialysis patients: is there anything left to eat?. Semin Dial 2015; 28: 159-168 doi:10.1111/sdi.12348
    CrossrefPubMedGoogle Scholar
  • 20 Kalantar-Zadeh K, Regidor DL, Kovesdy CP. et al. Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation 2009; 119: 671-679 doi:10.1161/CIRCULATIONAHA.108.807362
    CrossrefPubMedGoogle Scholar
  • 21 Pillon L, Piccoli A, Lowrie EG. et al. Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis. Kidney Int 2004; 66: 1266-1271 doi:10.1111/j.1523-1755.2004.00881.x
    CrossrefPubMedGoogle Scholar
  • 22 National Kidney Foundation Thirst Tips for Dialysis Patients Im Internet: https://www.kidney.org/newsletter/thirst-tips-dialysis-patients Stand: 08.10.2019
  • 23 Song JH, Lee SW, Suh CK, Kim MJ. Time-averaged concentration of dialysate sodium relates with sodium load and interdialytic weight gain during sodium-profiling hemodialysis. Am J Kidney Dis 2002; 40: 291-301 doi:10.1053/ajkd.2002.34507
    CrossrefPubMedGoogle Scholar
  • 24 Gotch FA, Evans MC, Keen ML. Measurement of the effective dialyzer Na diffusion gradient in vitro and in vivo. Trans Am Soc Artif Intern Organs 1985; 31: 354-358
    Google Scholar
  • 25 Dunlop JL, Vandal AC, Marshall MR. Low dialysate sodium levels for chronic haemodialysis. Cochrane Database Syst Rev 2019; 1: CD011204 doi:10.1002/14651858.CD011204.pub2
    PubMedGoogle Scholar
  • 26 Kim DY, Kim B, Moon KH, Lee S, Lee DY. Effect of gradually lowering dialysate sodium concentration on the interdialytic weight gain, blood pressure, and extracellular water in anuric hemodialysis patients. Ren Fail 2014; 36: 23-27 doi:10.3109/0886022X.2013.830360
    CrossrefPubMedGoogle Scholar
  • 27 Davenport A. Audit of the effect of dialysate sodium concentration on inter-dialytic weight gains and blood pressure control in chronic haemodialysis patients. Nephron Clin Pract 2006; 104: c120-c125 doi:10.1159/000094544
    CrossrefPubMedGoogle Scholar
  • 28 Rayner HC, Zepel L, Fuller DS. et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2014; 64: 86-94 doi:10.1053/j.ajkd.2014.01.014
    CrossrefPubMedGoogle Scholar
  • 29 Movilli E, Camerini C, Gaggia P. et al. Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients. Am J Nephrol 2018; 48: 79-86 doi:10.1159/000491552
    CrossrefPubMedGoogle Scholar
  • 30 Farese S, Kruse A, Pasch A. et al. Glycyrrhetinic acid food supplementation lowers serum potassium concentration in chronic hemodialysis patients. Kidney Int 2009; 76: 877-884 doi:10.1038/ki.2009.269
    CrossrefPubMedGoogle Scholar
  • 31 Aslam S, Saggi SJ, Salifu M, Kossmann RJ. Online measurement of hemodialysis adequacy using effective ionic dialysance of sodium-a review of its principles, applications, benefits, and risks. Hemodial Int 2018; 22: 425-434 doi:10.1111/hdi.12623
    CrossrefPubMedGoogle Scholar