Dialysate sodium delivery can alter chronic blood pressure management

Flanigan, Michael J.; Khairullah, Quresh; Lim, Victoria S.

doi:10.1016/s0272-6386(97)90199-2

Cited by 82 publications

(59 citation statements)

References 36 publications

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“…The authors showed that the difference between dialysate TAC sodium and pre-HD plasma sodium had a modest but significant correlation with interdialytic ambulatory diastolic BP (r ϭ 0.36, P Ͻ 0.05) (33). These findings were consistent with those of other investigators who evaluated the effect of this dialysate-to-plasma sodium gradient on dialysis sodium losses (34) and IDWG (5,31,35,36). Figure 1.…”

Section: Sodium Balance and Bp In Hemodialysissupporting

confidence: 82%

Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Santos

Peixoto

2008

Clinical Journal of the American Society of Nephrology

132

100

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Hypertension and chronic volume overload are complications often seen in hemodialysis patients. Current hemodialysis practices adopt a standard dialysate sodium prescription that is typically higher than the plasma sodium concentration of most patients. As a general rule, hemodialysis patients have stable predialysis plasma sodium concentrations, and each patient has a fixed "osmolar set point." Hypertonic dialysate sodium prescriptions, including sodium modeling, predispose to positive sodium balance and lead to higher blood pressure and increased interdialytic weight gain. Conversely, lowering or individualizing dialysate sodium reduces thirst, interdialytic weight gain, and blood pressure in non-hypotension prone dialysis patients. Optimization of the dialysate sodium prescription is an important step in achieving sodium balance and improving blood pressure control in hypertensive hemodialysis patients.

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Section: Sodium Balance and Bp In Hemodialysissupporting

confidence: 82%

Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Santos

Peixoto

2008

Clinical Journal of the American Society of Nephrology

132

100

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“…Even with the best of intentions, standardized prescriptions can still lack consistency. For example, HD patients exhibit a range of serum sodium values before dialysis and tend to defend their unique setpoints [25]; therefore, a fixed dialysate sodium concentration will not have a universal effect. The only way to ensure complete elimination of these differences is through the use of a biofeedback system setting the sodium balance, but safety data in paediatrics are not yet available.…”

Section: Discussionmentioning

confidence: 99%

Blood-volume monitoring in paediatric haemodialysis

et al. 2008

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A correlation between relative blood volume (RBV) reduction and adverse intradialytic events has been reported in children. Our aim was to determine whether the shape of the RBV curve and the RBV thresholds discriminated between haemodialysis treatments where patients developed complications and those where they did not. We retrospectively reviewed blood volume records (n = 74), using the Fresenius module. "Treatment complications" were defined as hypotension and/or intradialytic symptoms requiring nursing intervention. Treatments with complications were significantly associated with changes in heart rate (P = 0.05) and steeper decline of the RBV curve in the first hour (P = 0.01), but the final RBV measurement was not predictive (P = 0.27). When receiver operator characteristic (ROC) analyses were used, cut-off RBV thresholds of 88% at the end of the first hour, 84% at the end of the second hour, and 82% at the end of the third hour of dialysis, were able to discriminate between treatments with and without complications, but no RBV values at the end of the fourth hour of dialysis were discriminatory. The RBV curve differed in polyuric patients, such that complications occurred at lower RBV thresholds than in oliguric patients. Evolution of tachycardia and a steeper RBV fall in the first hour of dialysis predicted the occurrence of treatment complications.

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“…30 Sodium gain may arise even at standard dialysate sodium (ie, 140 mEq/L) when patients start dialysis with a lower serum sodium concentration (ie, <140 mEq/L). 31 Apart from raising interdialytic weight gain and BP, this positive sodium gradient may be of particular importance in pathogenesis of intradialytic hypertension. A direct association between the dialysateto-serum sodium gradient and change in SBP during dialysis was observed in 206 hemodialysis patients.…”

Section: Sodiummentioning

confidence: 99%