Effects of individualized dialysate sodium prescription in hemodialysis – Results from a prospective interventional trial

Radhakrishnan, Radhika; Varughese, Santosh; Chandran, Abitha; Jacob, Shibu; David, Vinoi George; Schmeißer, Alexander; Mohapatra, Anjali; Valson, Anna T; Basu, Gopal; Palani, Colathur K.; Jose, Arun Pulikkottil; Antonisamy, B.; Tamilarasi, V

doi:10.4103/ijn.ijn_391_18

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…But studies which individualized dialysate sodium did find significant difference in the IDWG with less intradialytic symptoms 13,28,29 . The study done by Radhakrishnan et al 17 found significant difference in IDWG with individualized sodium dialysate. The dissociation between IDWG and BP in our study raises the issue of volume independent effect of sodium on IDH 11,12 .…”

Section: Discussionmentioning

confidence: 96%

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Effect of low dialysate sodium in the management of intradialytic hypertension in maintenance hemodialysis patients: A single‐center Indian experience

Nair

Karthikeyan

Ramasamy

et al. 2021

Hemodialysis International

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Background High dialysate sodium is a significant contributor to intradialytic hypertension (IDH) in maintenance hemodialysis patients. In this study, we aimed to study the effect of low dialysate sodium on IDH in Indian hemodialysis patients. Materials and Methods Fifty patients on maintenance hemodialysis for atleast 3 months with episodes of IDH were enrolled in this study. The study was performed in two different stages. In the first phase, patients were dialyzed with standard dialysate sodium (140 mEq/L) for eight consecutive sessions and in the second phase, they were dialyzed with low sodium dialysate (136 mEq/L) for eight consecutive sessions. Differences in pre, intradialytic, and post‐HD blood pressure, interdialytic weight gain, mean serum sodium, intradialytic adverse events, and number of IDH episodes requiring intervention between the two phases were assessed. Results The mean age of the study population was 52 years (36 males,14 females). The mean post‐HD systolic and diastolic BP was 163.26 ± 9.58 mmHg and 88.60 ± 5.27 mmHg in the standard dialysate phase and 142.38 ± 14.09 mmHg and 84.58 ± 4.276 mmHg, respectively, in the low dialysate phase (p < 0.01). Interdialytic weight gain was 3.34 ± 0.9 and 3.11 ± 0.86 in the standard and low sodium dialysate phases, respectively (p = 0.19).The mean pre‐HD plasma sodium level was 138.48 ± 3.69 and 135.80 ± 1.35 mEq/dl, respectively, in standard and low dialysate phases (p = 0.01). There was significant reduction in number of IDH episodes requiring intervention. There was no difference in hypotensive episodes, adverse events between the two phases. Conclusion In patients with intradialytic hypertension, low dialysate sodium significantly reduces the post‐HD blood pressure and intradialytic hypertensive episodes, when compared with standard sodium dialysate.

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Section: Discussionmentioning

confidence: 96%

“…Sodium balance and extracellular volume control are the main factors in BP control in patients on maintenance HD 14 . It has been suggested that high dialysate sodium increases blood pressure, IDWG, left ventricular hypertrophy and even mortality 14–17 …”

Section: Discussionmentioning

confidence: 99%

Effect of low dialysate sodium in the management of intradialytic hypertension in maintenance hemodialysis patients: A single‐center Indian experience

Nair

Karthikeyan

Ramasamy

et al. 2021

Hemodialysis International

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“…There was a signi cantly lower interdialytic weight gain and pre-dialysis systolic blood pressure in those patients who had an individualised dialysate sodium concentration in comparison to the standard dialysate sodium concentration of 140 meq/l (16).…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 90%

Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis

Manji¹,

Shah²,

Twahir³

et al. 2020

Preprint

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BackgroundChronic kidney disease is highly prevalent across the globe with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.MethodsThis study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137meq/l and 140meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results41 patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137meq/l group and 2.35 for the 140meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). ConclusionThere was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain although further studies with a larger sample size are warranted.

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“…It is important to note that there was no exclusion of patients with residual renal function in this study, yet residual renal function (defined as urine output of greater than 200 ml/day) theoretically has a physiologic role in sodium balance [ 14 ]. Ipema et al established that patients with residual diuresis had significantly lower interdialytic weight gain [ 15 , 16 ]. However in terms of outcomes, Hecking et al noted no difference in mortality in patients with or without residual renal function in spite of the dialysate sodium concentrations used [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was shown in a study conducted by Radhakrishnan et al where they compared a set dialysate sodium concentration of 140 meq/l to an individualised dialysate sodium concentration. There was a significantly lower interdialytic weight gain and pre-dialysis systolic blood pressure in those patients who had an individualised dialysate sodium concentration in comparison to the standard dialysate sodium concentration of 140 meq/l [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Association between dialysate sodium concentration and interdialytic weight gain in patients undergoing twice weekly haemodialysis

et al. 2021

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Background Chronic kidney disease is highly prevalent across the globe with more than 2 million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes. Methods This study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137 meq/l and 140 meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results Forty-one patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137 meq/l group and 2.35 for the 140 meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137 meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140 meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137 meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140 meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). Conclusion There was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain or blood pressure although further studies are warranted with a larger sample size, taking into account residual renal function and longer duration for impact on blood pressures.

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Effects of individualized dialysate sodium prescription in hemodialysis – Results from a prospective interventional trial

Cited by 11 publications

References 14 publications

Effect of low dialysate sodium in the management of intradialytic hypertension in maintenance hemodialysis patients: A single‐center Indian experience

Effect of low dialysate sodium in the management of intradialytic hypertension in maintenance hemodialysis patients: A single‐center Indian experience

Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis

Association between dialysate sodium concentration and interdialytic weight gain in patients undergoing twice weekly haemodialysis

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