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

Authors

Deepak Malhotra, Department of Medicine, University of Toledo School of Medicine, Toledo, Ohio, USA.
Susie Q. Lew, Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Raymond E. Garrett, Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.
Ramin Sam, Department of Medicine, Zuckerberg San Francisco General Hospital and the University of California in San Francisco School of Medicine, San Francisco, California, USA.
Robert H. Glew, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Todd S. Ing, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
Antonios H. Tzamaloukas, Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

Document Type

Journal Article

Publication Date

3-6-2025

Journal

Hemodialysis international. International Symposium on Home Hemodialysis

DOI

10.1111/hdi.13205

Keywords

four‐stream dialysis system; hemodialysis; hypernatremia; hyponatremia; metabolic acidosis; metabolic alkalosis

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.

APA Citation

Malhotra, Deepak; Lew, Susie Q.; Garrett, Raymond E.; Sam, Ramin; Glew, Robert H.; Ing, Todd S.; and Tzamaloukas, Antonios H., "Concurrent Control of Sodium and Bicarbonate Serum Concentrations Using a Four-Stream Hemodialysis Fluid Delivery System" (2025). GW Authored Works. Paper 6846.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6846

Department

Medicine