High versus low dialysate sodium concentration in chronic haemodialysis patients: a systematic review of 23 studies

Basile, Carlo; Pisano, Anna; Lisi, Piero; Rossi, Luigi; Lomonte, Carlo; Bolignano, Davide

doi:10.1093/ndt/gfv084

Cited by 46 publications

(42 citation statements)

References 33 publications

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“…Although some observational studies have reported lower weight gains and lower blood pressure with lowering the dialysate sodium concentration, other studies only noted a minor effect, and others reported increased mortality associated with lower dialysate sodium . As such there has been debate as to the optimum choice of dialysate sodium …”

Section: Introductionmentioning

confidence: 99%

Reliability of delivered dialysate sodium concentration

Ekbal¹,

Consalus²,

Persaud

et al. 2016

Hemodialysis International

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Background The results of studies investigating the effects of hyponatraemic dialysates have been mixed, with some reporting positive effects including reduction in blood pressure and inter-dialytic weight gains, whereas others have not been able to demonstrate any effect. These studies assume that setting a lower dialysate sodium results in the delivery of a hyponatraemic dialysate. We therefore measured delivered sodium to determine reliability. Methods We measured dialysate sodium in 10 BBraun Dialog+ and 6 Fresenius 4008H dialysis machines, which had been set up to deliver a sodium of 136 mmol/L, using flame photometry and indirect ion selective electrode (ISE) methods. Results Dialysate conductivity was 13.85 ± 0.05 mS/cm, but dialysate sodium measured by flame photometry was 141.8 ± 2.9 mmol/L, and 142.5 ± 2.4 mmol/L by ISE. Both dialysis machines delivered a dialysate sodium in excess of the 136 mmol/L set, with a mean bias of 7.0 ±2.1 mmol/L for the Dialog+ , and 3.7 ± 2.6 for the 4008 with the flame photometer method, and a mean bias of 6.3 ± 1.3 mmol/L for the Dialog+ , and 6.8 ± 3.7 for the 4008 by ISE. Conclusion It is assumed when setting a dialysate sodium concentration that this sodium concentration is delivered. However we found that the dialysate sodium concentration delivered was greater than that set, despite the dialysis machines reporting a conductivity measurement in keeping with a lower sodium dialysate. Trials of lowered dialysate sodium therefore need to measure dialysate sodium concentrations to ensure what has been set is delivered.

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Section: Introductionmentioning

confidence: 99%

Reliability of delivered dialysate sodium concentration

Ekbal¹,

Consalus²,

Persaud

et al. 2016

Hemodialysis International

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“…Studies for which sodium was the active ingredient were not considered in the review. Studies focusing on the electrolytic composition of dialysis solutions, a specific topic which has already been reviewed elsewhere [15], or enteral/parenteral nutrition were also excluded from the present review. The study designs of interest included: experimental studies (randomized controlled trials) and quasi-experimental studies (non-randomized controlled trials, controlled or non-controlled before-after studies and interrupted time series), observational studies (cross-sectional, retrospective/prospective cohort, or case-control studies).…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular risk associated with high sodium-containing drugs: A systematic review

Perrin¹,

Korb-Savoldelli²,

Karras³

et al. 2017

PLoS ONE

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BackgroundExcess dietary sodium is associated with increased blood pressure (BP). Some drugs are associated with high sodium intake (in particular effervescent tablets), but the cardiovascular risk associated with such high sodium-containing drugs (HSCD) is largely underevaluated.ObjectivesTo summarize the evidence for a potential cardiovascular risk associated with exposure to HSCD, and to highlight possible risk factors associated with this iatrogenic issue; in general and/or specific populations.MethodsWe conducted a systematic review, by searching electronic databases including MEDLINE, EMBASE, Web of Science, CENTRAL and grey literature between 1960 and 2015. We included studies that reported modification of cardiovascular parameters or incidence/prevalence of cardiovascular outcomes, between a group of subjects exposed to HSCD relative to a non-exposed group. The threshold used to identify HSCD was 391 mg/day. We did not consider studies evaluating exposure to sodium as an active ingredient or those focusing on dialysis solutions or enteral/parenteral nutrition. Study quality was assessed using the EPHPP tool.ResultsA total of eight studies met our inclusion criteria. Four reported results for short-term exposure to HSCD (≤ 7 days) on BP fluctuations. One study reported an elevation of BP (associated sodium intake: 1,656 mg/day). Four studies evaluated a long-term exposure (≥ 2 years or discontinuation of a chronic treatment). Two studies reported iatrogenic risk. For these studies, drug associated sodium intake was high (> 1,500 mg/day) in patients with comorbidities (in particular, diabetes mellitus and hypertension).ConclusionDespite numerous study limitations, this systematic review suggests three potential synergistic risk factors for cardiovascular complications after exposure to HSCD: a high sodium intake (≥ 1,500 mg/day), a long duration of exposure, and the presence of comorbidities. Further studies are required to characterize this iatrogenic risk.Trial registrationPROSPERO CRD42016047086.

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“…On the contrary, patients treated with higher dialysate Na can tolerate the HD session better, but often at the price of higher IDWG and increased thirst and blood pressure levels [60, 61]. …”

Section: Management Of Fluid Overloadmentioning

confidence: 99%

Assessment and management of fluid overload in children on dialysis

Hayes

Paglialonga

2018

Pediatr Nephrol

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Dysregulation of intravascular fluid leads to chronic volume overload in children with end-stage kidney disease (ESKD). Sequelae include left ventricular hypertrophy and remodeling and impaired cardiac function. As a result, cardiovascular complications are the commonest cause of mortality in the pediatric dialysis population. The clinical need to optimize intravascular volume in children with ESKD is clear; however, its assessment and management is the most challenging aspect of the pediatric dialysis prescription. Minimizing chronic fluid overload is a key priority; however, excessive ultrafiltration is toxic to the myocardium and can precipitate intradialytic symptoms. This review outlines emerging objective techniques to enhance the assessment of fluid overload in children on dialysis and outlines evidence for current management strategies to address this clinical problem.

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High versus low dialysate sodium concentration in chronic haemodialysis patients: a systematic review of 23 studies

Cited by 46 publications

References 33 publications

Reliability of delivered dialysate sodium concentration

Reliability of delivered dialysate sodium concentration

Cardiovascular risk associated with high sodium-containing drugs: A systematic review

Assessment and management of fluid overload in children on dialysis

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