Individualizing the dialysate XXXX concentration.

@entity1 @entity455 @entity79 @entity460 @entity209 @entity943
PURPOSE OF REVIEW: The optimal dialysate @entity460 concentration (DCC) in hemodialysis @entity1 is still debated. Strategies have varied over time due to developments in the treatments available for mineral @entity209 and our increasing knowledge of bone and @entity455 . International recommendations [Kidney Disease Outcomes Quality Initiative (KDIGO) and European Best Practice Guidelines] urge for DCC individualization in order to meet the @entity1 's specific needs whenever possible. In this review, we aim to discuss the pros and cons of individualizing the DCC in hemodialysis @entity1 . RECENT FINDINGS: Different regions of the world have various strategies with respect to DCCs. Decreasing the DCC slightly reduces calcemia, but mainly stimulates @entity79 . Conversely, increasing the DCC increases calcemia slightly and reduces @entity79 markedly. Furthermore, higher DCCs favor hemodynamic stability and can prevent @entity943 . The impact of DCC individualization on survival rate or cardiovascular calcification progression has not been evaluated. SUMMARY: Individualizing DCC appears to be useful but requires time, a clear defined strategy, and close biological monitoring. Even though some studies have shown that using individualized DCCs of 1.25 or 1.75mmol/l is not harmful, the real benefits of this strategy need to be assessed in a large, multicentric trial.
