Effects of Low Sodium Dialysate in Chronic Hemodialysis Patients: An Echocardiographic Study

Abstract

A reduction of the dialysate sodium concentration based on the predialysis sodium levels of the patients could reduce the systolic BP and decrease the volume load on the heart as assessed by echocardiography. Within this short period, postdialysis diastolic BP could not be lowered. The effect of this approach should be studied in broad and lengthy series.

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

“…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].…”

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

“…In a recent study, Sayarlioglu et al (46) used the predialysis sodium of 18 patients as a reference to set the dialysate sodium concentration. For those patients who had pre-HD sodium less than 137 mEq/L, the dialysate sodium was modified to 135 mEq/L, and for those with pre-HD sodium over 137 mEq/L, the dialysate sodium was modified to 137 mEq/L.…”

Increasing the Dialysate Sodium Concentration Based on Serum Sodium Concentrations Exacerbates Weight Gain and Thirst in Hemodialysis Patients

“…In contrast, diffusive sodium loss can lead to intradialytic symptoms, such as hypotension and muscle cramps, if the sodium concentration is lower in the dialysate than in serum (negative sodium gradient). Previous studies have reported that reduction in dialysate sodium based on pre-HD plasma sodium levels improves thirst, interdialytic weight gain (IDWG), hypertension and intradialytic hypotension (Murisasco et al 1985;de Paula et al 2004;Sayarlioglu et al 2007). However, we could not find any studies on individualized dialysate sodium prescriptions for patients who have serum sodium concentrations higher than typical dialysate sodium concentrations.…”