Low dialysate sodium levels for chronic haemodialysis

Abstract

Low dialysate sodium levels for chronic haemodialysis.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Prospective studies suggest that use of lower dialysate sodium is associated with lower IDWG and BP 90,91 but also show an association with intradialytic hypotension and symptoms, including cramps. 92 Observational studies have yielded mixed results regarding the association of dialysate sodium and mortality. [93][94][95] The Sodium Lowering in Dialysate (SoLID) RCT 96,97 assesses the effects of low versus standard dialysate sodium concentration on regression of left ventricular mass, with results pending.…”

Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

“…However, the random allocation of treatment periods should have attenuated this bias due to temporal fluctuations in diet. The ideal DNa remains controversial [23]. In a general HD population, dialyzing with lower sodium concentrations has been reported as a safe technique [7].…”

Temporal changes in dialysate [Na+] prescription from 1996 to 2018 and their clinical significance as judged from a meta‐regression of clinical trials

“…Against this background, one of the most accepted surrogate markers of CV risk is left ventricular (LV) hypertrophy 14‐17 . One of the strongest predictors of LV mass is fluid overload, and one of the axiomatic causes of fluid overload is salt loading either through dialysate, diet, and/or inadequate ultrafiltration 4 . The possibility that lower dialysate [Na + ] might benefit LV mass has been studied in two recent and randomized clinical trials 9,18 .…”

“…2,3 Recently, there has been renewed interest in lower dialysate [Na + ] as a means for controlling fluid volume, supported by positive qualitative and quantitative reviews of cumulative clinical experience. 4,5 This has provided a much needed evidence base to support the various "calls to action" from clinical governance groups that have made specific clinical recommendations in this area. Nonetheless, de-…”