V ARIABILITY IN DIALYSATE SODIUM CONCENTRATION AND ITS EFFECT ON SERUM SODIUM LEVELS

Abstract Background and Aims The dialysate sodium prescription remain unclear as an important component of sodium balance in HD patients Pre-hemodialysis (pre-HD) serum sodium levels can vary among different patients, therefore, a single dialysate sodium prescription may not be appropriate for all patients. Dialysate sodium is one of the most easy changeable parameter which can influence hemodynamic stability. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of prescription of different models of dialysate sodium Method 77 nondiabetic subjects (41 men; 36 women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration set up at 138 mmol/L, followed by additional 3 models of dialysate sodium (each model performed 2 months sessions with 2 months standard dialysate sodium between each model) wherein dialysate sodium was set up: model 1: according to pre-HD serum sodium concentration, model 2: according to sodium concentration in UF fluid, model 3: sodium profiling ( from 144 to 136 mmol/L). Blood pressure (BP), interdialytic weight gain (IDWG), thirst score, sodium gradient were analysed. After the standard dialysate sodium hemodialyses, the subjects were divided into 3 groups: normotensive (N=58), hypertensive (N= 14) and hypotensive (N=5) based on the average pre-HD systolic BP during the standard dialysate sodium hemodialyses. Results Model 1: resulted in significantly lower blood pressure (133,61±11.88 versus 153.60±14.26 mmHg; p=0.000) and IDWG (2.21±0.93 versus 1.87±0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21±0.72 versus 2.06±0.65, p=0,004). Hypertensive patients had significant highest sodium gradient compared to other patients (p<0.05), followed by significant increase of 0,6% IDWG confirmed with univariate regression analysis. Thirst score was significantly lower in all patients with individualized-sodium HD and the use of antihypertensive drugs significantly reduced in hypertensive patients during the individualized phase. Model 2: resulted in significantly lower BP in normotensive and hypertensive patients (126.92±9.71 versus 124.08±8.71 mmHg; p=0.000; 153.60±14.26 versus 138.91±8.48 mmHg, accordingly), with no influence on IDWG, thirst score compared to standard dialysate sodium. Model 3: significantly higher BP and IDWG in all 3 groups (normotensive 126.92±9.71 versus 130.20±9.5 mmHg; p=0.001; IDWG 2.21±0.72 versus 2.34±0.82 kg, p=0,005; hypertensive 153.60±14.26 versus 157.58±5.0 mmHg; IDWG 2.21±0.93 versus 2.39±0.74 kg; p=0.005; hipotensive 79.81±11.78 versus 91.09±24.98 mmHg, IDWG 2.53±0.57 versus 2.73±0.15 kg, p=0.005) and significantly higher thirst score in normotensive and hypotensive patients, with no influence in hypertensive patients. Conclusion A reduction of the dialysate sodium concentration based on the pre HD serum sodium level of the patient, reduced the BP, IDWG, thirst score and use of antihypertensive drug compare to dialysate sodium according to sodium concentration in UF or sodium profiling. We recommend prescription of dialysate sodium according to pre HD serum sodium concentration.

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How to Adjust the Sodium Concentration in Dialysate Individually and Practically?

Kidney and Dialysis ◽

10.3390/kidneydial1020023 ◽

2021 ◽

Vol 1 (2) ◽

pp. 161-163

Author(s):

Jingjing Zhang

Keyword(s):

Serum Sodium ◽

Observational Studies ◽

Serum Sodium Level ◽

Volume Overload ◽

Sodium Concentration ◽

Study Data ◽

Chronic Hemodialysis ◽

Low Sodium ◽

Large Cohort Study ◽

Dialysate Sodium

The optimal dialysate sodium concentration for chronic hemodialysis patients remains controversial. Conflicting data from small observational studies and large cohort study data have not convinced nephrologists to choose either a high or low sodium dialysate. Despite a lack of evidence, I would prescribe individualized dialysate sodium concentrations for patients with a risk of hypertension or volume overload, aligning the dialysate sodium concentration with patients’ predialysis serum sodium level. The concentration of dialysate sodium would usually be 0–2 mEq/L below the patient’s serum sodium concentration. I believe that this strategy would help improve hypertension, intradialytic weight gain, cardiac outcomes, and deliver precision medicine.

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MO724IS INDIVIDUALIZED DIALYSATE SODIUM REASON FOR BETTER SURVIVAL IN HEMODIALYSIS PATIENTS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab097.004 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Natasha Eftimovska-Otovikj ◽

Natasha Petkovikj ◽

Olivera Stojceva-Taneva

Keyword(s):

Serum Sodium ◽

Well Being ◽

Sodium Concentration ◽

Left Ventricular ◽

Serum Sodium Concentration ◽

Laboratory Parameters ◽

Interdialytic Weight Gain ◽

Sodium Gradient ◽

Set Up ◽

Dialysate Sodium

Abstract Background and Aims We are uncertain about whether dialysate sodium improves overall health and well-being for people on haemodialysis, since there are a mixture of probably good and bad effects. Dialysate sodium is one of the most easy changeable parameter which can inﬂuence hemodynamic stability, echocardiography and laboratory parameters. The aim of the study was to investigate whether dialysis patients will have some beneﬁcial effects of dialysate sodium set up according to serum sodium. Method 77 nondiabetic subjects (41men; 36women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration setup at 138 mmol/L, followed by additional 24 month ssessions wherein dialysate sodium was set up according to pre-HD serum sodium concentration. Interdialytic weight gain (IDWG), echocardiography, laboratory parameters and survival were analysed. Results Sodium individualization resulted in signiﬁcantly lower IDWG by using individualized sodium according to pre HD serum sodium compared to standard dialysate sodium (2.17±0.79 vs 1.93±0.64 kg, p<0,001). In all patients we confirmed positive sodium gradient and univariate regression analysis showed that by increasing the sodium gradient by 1 mmol/L, IDWG increased by an average of 0.189% and 7,1% changes in IDWG can be explain by changing of the sodium gradient. Echocardiography analysis showed an increase of 2.04 mm of left ventricular diastolic diameter (LVDD) by increasing the sodium gradient for 1mmol/L and signiﬁcantly increased left ventricular mass (LVM) of 35.69 gr by 1kg increase of IDWG. Laboratory analysis showed statistical significant increase in Kt/V, URR (urea reduction rate), serum albumin and hemoglobin by using individualized dialysed sodium compared to standard dialysate sodium, respectively (1.50±0.24 vs 1.36±0.22; 70.80±5.24 vs 67.00±6.23%; 38.23±3.80 vs 34.46±2.53 g/L; 120.32±10.14 vs 114.62±10.34 g/L, p<0.001). We confirmed significant decrease in serum potassium, with no change in other electrolities (5.62±0.60vs 5.15±0.94). During the study, 7 patients died and binary logistic regression univariate analysis showed that significant predictors of mortality in patients dialyzed with individualized sodium dialysis according to pre-HD plasma sodium concentrations were Kt/V, URR, and CRP (C reactive protein). Analysis showed that patients with Kt/V lower than 1,2 have 8.8 times higher risk for death compared to patients with Kt/V>1,2, URR lower than 65% have 10,9 times higher risk compared to URR>65% and CRP higher than 10 mg/L have 10.2 times higher risk for death compared to patients with CRP lower than 10 mg/L Conclusion Individualization of dialysate sodium according to pre HD serum sodium concentration result in better IDWG control, improvement of fluid overload and regression of left ventricular hypertrophy, better dialysis adequacy and higher survival compared to standard dialysate sodium.

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Impact of sodium profiling on ambulatory blood pressure in patients on maintenance hemodialysis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh160224022z ◽

2017 ◽

Vol 145 (3-4) ◽

pp. 141-146

Author(s):

Li-Hui Zhai ◽

Yue-Yue Zhang ◽

Yan Xu ◽

Wen-Juan Yin ◽

Lin Li ◽

...

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Serum Sodium ◽

Sodium Concentration ◽

Maintenance Hemodialysis ◽

Interdialytic Weight Gain ◽

Group A ◽

Group B ◽

Stage Renal Disease ◽

Dialysate Sodium

Introduction/Objective. Most patients with end-stage renal disease (ESRD) have hypertension. However, dialysis-related strategies to optimize blood pressure in these patients remain controversial. The current study aims to investigate the influence of dialysate sodium profiling on ambulatory blood pressure (ABP) in patients on maintenance hemodialysis, when there are no adequate dialytic and economic resources or high patient compliance. Methods. This prospective, single-center study enrolled 60 hypertensive ESRD patients. Subjects received maintenance dialysis with regular dialysate sodium concentration (140 mmol/L) during the initial three months after the enrollment, and were randomly assigned to continue regular sodium dialysate (group A) or switch to sodium profiling (group B) for duration of three months. ABP, heart rate (HR), pre-/postdialysis serum sodium levels, antihypertensive treatment dosages, and interdialytic weight gain (IDWG) etc. were recorded after treatment assignment. Results. Thirty patients each were enrolled in groups A and B. The characteristics at baseline were not significantly different between the two groups. Compared to patients in group A three months later, patients in group B had lower systolic ABP (p = 0.00), HR (p = 0.04), IDWG (p = 0.04), and antihypertensive medication dosages (p = 0.04). Throughout the treatment duration, no significant inter-group differences were observed for pre-/post-dialysis serum sodium and intradialytic complications. Additionally, no significant correlations were found between systolic or diastolic ABP and other variables studied in this study. Conclusion. In this study, we found that dialysate sodium profiling successfully ameliorated hypertension and reduced BP medications without altering natremic levels or increasing complications among patients on maintenance hemodialysis during the three months. Dialysate sodium profiling was relatively safe in this duration.

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What Is the Optimal Dialysate Sodium Concentration?

Kidney and Dialysis ◽

10.3390/kidneydial1020022 ◽

2021 ◽

Vol 1 (2) ◽

pp. 157-160

Author(s):

Elizabeth Lindley ◽

James Tattersall

Keyword(s):

Fluid Balance ◽

Serum Sodium ◽

Sodium Intake ◽

Sodium Concentration ◽

Sodium Removal ◽

Lower Fluid ◽

Dialysate Sodium

In haemodialysis, sodium and fluid balance (where intake matches loss) is achieved by ultrafiltration and by diffusion between the plasma water and dialysate. If a patient’s sodium intake does not change, any reduction in fluid gain obtained by lowering dialysate sodium concentration will result in less sodium removal by ultrafiltration. The corresponding change in diffusion to achieve balance may mean the benefit of lower fluid gain is offset by morbidity caused by a fall in serum sodium during dialysis. The standard dialysate sodium should minimise harm caused by both high ultrafiltration rates and osmotic disequilibrium. For most units, this is likely to be 138 to 140 mmol/L.

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Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration

Liver International ◽

10.1111/j.1478-3231.2010.02293.x ◽

2010 ◽

Vol 30 (8) ◽

pp. 1137-1142 ◽

Cited By ~ 53

Author(s):

Mónica Guevara ◽

María E. Baccaro ◽

Jose Ríos ◽

Marta Martín-Llahí ◽

Juan Uriz ◽

...

Keyword(s):

Risk Factors ◽

Hepatic Encephalopathy ◽

Serum Sodium ◽

Sodium Concentration ◽

Serum Sodium Concentration ◽

Refractory Ascites

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Serum Sodium Concentration Changes Are Related to Fluid Balance and Sweat Sodium Loss

Medicine & Science in Sports & Exercise ◽

10.1249/mss.0b013e3181d6c72a ◽

2010 ◽

Vol 42 (9) ◽

pp. 1669-1674 ◽

Cited By ~ 11

Author(s):

MATTHEW D. PAHNKE ◽

JOEL D. TRINITY ◽

JEFFREY J. ZACHWIEJA ◽

JOHN R. STOFAN ◽

W. DOUGLAS HILLER ◽

...

Keyword(s):

Fluid Balance ◽

Serum Sodium ◽

Sodium Concentration ◽

Serum Sodium Concentration ◽

Concentration Changes ◽

Sodium Loss ◽

Sweat Sodium

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Bias in the Determination of Dialysate Sodium Concentration Set According to Conductivity Relative to Indirect Ion-Selective Measurement Techniques

Kidney International Reports ◽

10.1016/j.ekir.2020.03.001 ◽

2020 ◽

Vol 5 (6) ◽

pp. 931-934

Author(s):

Rayees Sheikh ◽

Swapnil Hiremath ◽

Edward G. Clark ◽

Ayub Akbari ◽

Christopher McCudden ◽

...

Keyword(s):

Measurement Techniques ◽

Sodium Concentration ◽

Dialysate Sodium

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Atrial natriuretic peptide suppresses osmostimulated vasopressin release in young and elderly humans

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1991.261.2.e252 ◽

1991 ◽

Vol 261 (2) ◽

pp. E252-E256 ◽

Cited By ~ 1

Author(s):

B. A. Clark ◽

D. Elahi ◽

L. Fish ◽

M. McAloon-Dyke ◽

K. Davis ◽

...

Keyword(s):

Atrial Natriuretic Peptide ◽

Hypertonic Saline ◽

Natriuretic Peptide ◽

Serum Sodium ◽

The Elderly ◽

Sodium Concentration ◽

Elderly Subjects ◽

Vasopressin Release ◽

Young And Elderly Subjects ◽

Atrial Natriuretic

Atrial natriuretic peptide (ANP) may suppress vasopressin release, but the dynamics of this interaction as well as the influence of age have not been defined. We studied six or seven young (19-40 yr old) and seven elderly volunteers (65-83 yr old) under two circumstances: 1) after infusion of 5% saline (0.04 ml.kg-1.min-1) for 2 h and 2) after the same infusion given with simultaneous synthetic human ANP (0.05 micrograms.kg-1.min-1). Hypertonic saline alone produced a progressive rise in plasma vasopressin with increasing serum sodium. During hypertonic saline alone, vasopressin levels began to rise at an increment in serum sodium of 1.67 +/- 0.35 mM in the young and 1.43 +/- 0.32 mM in the elderly and rose linearly with increasing serum sodium. When ANP was infused with hypertonic saline (with peak ANP levels of approximately 1,000 pM), vasopressin levels began to rise at an increment in serum sodium of 4.43 +/- 0.67 mM in the young and 4.57 +/- 0.43 mM in the elderly (P less than 0.01 vs. saline alone). Furthermore, the vasopressin response for any given serum sodium was significantly reduced in both young and elderly subjects, resulting in a rightward displacement of the curve relating vasopressin response to sodium concentration (P less than 0.001). In conclusion, ANP not only suppresses vasopressin but raises the threshold for release of vasopressin in response to osmotic stimulation in both young and elderly individuals. High circulating ANP levels may be responsible in part for the suppression of vasopressin levels and water diuresis seen during states of volume expansion.

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