Sodium-Based Osmotherapy in Continuous Renal Replacement Therapy: A Mathematical Approach

Cerebral edema, in a variety of circumstances, may be accompanied by states of hyponatremia. The threat of brain injury from hypotonic stress-induced astrocyte demyelination is more common when vulnerable, hyponatremic patients with end-stage liver disease, traumatic brain injury, heart failure, or other conditions undergo overly rapid correction of hyponatremia. These scenarios, in the context of declining urinary output from chronic kidney disease and/or acute kidney injury, may require controlled elevations of plasma tonicity vis-a-vis increases of the plasma sodium concentration. We offer a strategic solution to this problem via sodium-based osmotherapy applied through a conventional continuous renal replacement therapy modality, pre-dilution continuous venovenous hemofiltration.