Clinical Effects of Standard and Individualized Dialysate Sodium in Patients on Maintenance Hemodialysis

Abstract

BACKGROUND:The degree to which the dialysate prescription and, in particular, the dialysate sodium concentration influences blood pressure and interdialytic weight gain (IDWG) via changes in sodium flux, plasma volume or the other parameters is not well understood. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium or sodium modeling.MATERIAL AND METHODS:Ninety-two nondiabetic subjects (52 men and 40 women) performed 12 consecutive hemodialysis (HD) sessions (4 weeks) with dialysate sodium concentration set up on 138 mmol/L (standard sodium – first phase), followed by 24 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic and mean blood pressure, pulse, IDWG, thirst score – (Xerostomia Inventory (XI) and Dialysis Thirst Inventory (DTI)) and side effects (occurrence of hypotension and muscle cramps). After the first phase, the subjects were divided into 3 groups: normotensive (N=76), hypertensive (N= 11) and hypotensive (N=5) based on the average pre-HD systolic BP during the whole period of the first phase.RESULTS:Sodium individualization resulted in significantly lower blood pressure (133.61 ± 11.88 versus 153.60 ± 14.26 mmHg; p=0.000) and IDWG (2.21 ± 0.93 versus 1.87 ± 0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21 ± 0.72 versus 2.06 ± 0.65, p=0,004). Sodium profiling in hypotensive patients significantly increased IDWG (2.45 vs. 2.74, p= 0,006), and had no impact on blood pressure. Thirst score was significantly lower in normotensive patients with individualized-sodium HD and showed no change in the other two groups. During the second phase, hypotension occurred in only 1 case and muscle cramps in 10 normotensive patients.CONCLUSION:Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients.

Interdialytic weight gain and low dialysate sodium concentration in patients on chronic hemodialysis: a systematic review and meta-analysis

“…Interestingly, the present systematic review shows that in most studies, the frequency of intradialytic hypotensive events did not differ significantly between patients receiving hemodialysis with low or high sodium dialysate concentration [ 22 , 26 , 27 , 30 , 32 , 34 , 35 , 39 ]. The study of Marshall et al only reported that hypotensive events were more frequent with lower sodium dialysate concentration [ 36 ].…”

A potential link between AQP3 and SLC14A1 gene expression level and clinical parameters of maintenance hemodialysis patients

“…Increased pre-dialysis sodium gradients has been found to be a potential contributory factor for increased IWG in HD patients [37]. Furthermore, some studies suggest that the reduction of sodium in the dialysate from 140 to 138 or 137 mmol/L, thus lowering its pre-dialysis gradient, seems to reduce inter-dialytic weight gain [38][39][40]. As such, based on these previous findings and the negative correlation observed between AQP3 expression and pre-dialysis sodium gradient in present study, the impact on AQP3 expression should be obvious; however, no direct correlation was observed between IGW and AQP3 expression.…”