Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients

Abstract

An individualized Na(+) dialysate based on predialysis plasma Na(+) levels decreases thirst, IDWG, HD-related symptoms, and pre-HD BP (in patients with uncontrolled BP at baseline).

Clinical Effects of Personalized Dialysate Sodium in Conventional, Quotidian, and Nocturnal Home Hemodialysis Patients: A Randomized Crossover Trial

“…Thirdly, haemodialysis duration associated with increased intradialytic fall in diastolic blood pressure. Previous research has consistently shown that increased haemodialysis time decreases ultrafiltration rate and risk of intradialytic hypotension [22,27,39,46] contrary to this study's findings. However, nocturnal haemodialysis patients often sleep during haemodialysis, so post-dialysis blood pressure is measured in the morning in a relaxed state, unlike the shorter haemodialysis sessions in conventional dialysis.…”

“…This is consistent with previous trials in thrice weekly conventional haemodialysis patients [27][28][29][30]. However, there was no difference in intradialytic change in systolic, diastolic or mean blood pressure between HIGHDialSOD and LOWDialSOD study periods.…”

“…In conventional thrice weekly haemodialysis, positive sodium balance is associated with IDWG, hypertension, left ventricular hypertrophy, cardiovascular morbidity and perhaps mortality [5,[26][27][28][29][30]36,37] although the relationship with mortality remains controversial [38]. The clinical effects of frequent or prolonged exposure to sodium concentrations have not been prospectively evaluated.…”

“…When the dialysate sodium concentration exceeds the SP, diffusion of sodium into the patient occurs, and a number of undesirable clinical outcomes result, including increased interdialytic weight gain (IDWG), blood pressure, and ultrafiltration rate [25][26][27][28][29][30]. These clinical outcomes are predicted by the magnitude not only of dialysate to pre-dialysis plasma sodium gradient (DPNa + ), but also by the post to pre-dialysis plasma sodium gradient (PPNa + ) [30].…”

Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

“…Using a patient's predialysis SNa as a reference to prescribe individualized or tailored DNa has thus been considered rational (3,10,11), and various prospective interventional trials have found a significant decrease in IDWG by reducing DNa (10,12). As a result of previous guidelines and recommendations (8,9,13) and recent observational studies and commentaries (7,14,15), DNa tailoring may become routine clinical practice.…”