scholarly journals Associations of a facility level decrease in dialysate sodium concentration with blood pressure and interdialytic weight gain

2007 ◽  
Vol 22 (9) ◽  
pp. 2630-2639 ◽  
Author(s):  
H. Thein ◽  
I. Haloob ◽  
M. R. Marshall
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Sodium Concentration ◽  
Interdialytic Weight Gain ◽  
Facility Level ◽  
Dialysate Sodium

scholarly journals P1051WHICH MODEL OF DIALYSATE SODIUM PRESCRIPTION TO CHOOSE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natasha Eftimovska-Otovikj ◽  
Natasha Petkovikj ◽  
Elizabeta Poposka ◽  
Olivera Stojceva-Taneva
Keyword(s):  
Blood Pressure ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Sodium Balance ◽  
Hypertensive Patients ◽  
Interdialytic Weight Gain ◽  
Sodium Gradient ◽  
Set Up ◽  
Dialysate Sodium

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.

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

2020 ◽  
Author(s):  
Soraiya Manji ◽  
Jasmit Shah ◽  
Ahmed Twahir ◽  
Ahmed Sokwala
Keyword(s):  
Weight Gain ◽  
Univariate Analysis ◽  
Sodium Concentration ◽  
University Hospital ◽  
Exact Test ◽  
Interdialytic Weight Gain ◽  
Significant Difference ◽  
Blood Pressures ◽  
The Mean ◽  
Dialysate Sodium

Abstract 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.

Clinical impact of personalized sodium prescriptions in hemodialysis

2022 ◽  
Vol 35 (4) ◽  
Author(s):  
Mariana Sousa ◽  
◽  
Cristina Santos ◽  
Susana Colaço ◽  
José Santos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Serum Sodium ◽  
Statistical Significance ◽  
Extracellular Volume ◽  
Qualitative Assessment ◽  
Sodium Balance ◽  
Patient Specific ◽  
Interdialytic Weight Gain ◽  
Dialysate Sodium

Dialysate sodium prescription is often standardized. In some patients, this can be hypernatremic compared to serum sodium, causing a positive sodium balance at the end of treatment that will contribute to increased extracellular volume and interdialytic weight gain. A prospective study was carried out to monitor and compare the clinical implications between different prescriptions of sodium dialysate (isonatremic versus hyponatremic hemodialysis). For that purpose, we included hemodialysis patients in treatment for at least 9 months. The individual sodium setpoint was determined through the median of pre-dialysis sodium measurements, carried out for 6 treatments. The prescribed dialysate sodium was equal to the setpoint (isonatremic period) for 4 weeks and then 2 meq/L inferior to the setpoint (hyponatremic period) for another 4 weeks. The main outcome was interdialytic weight gain. Secondary outcomes were ultrafiltration rate, blood pressure at the beginning of treatment, intradialytic complications, and qualitative assessment of symptoms. Twenty patients were included. Pre-dialysis serum sodium assessments in both periods tended to be patient specific with a stable value. The interdialytic weight gain was lower in the hyponatremic period (1.83±0.50 kg versus 2.04±0.58 kg) but without statistical significance (p value=0.387). The same trend was found in mean ultrafiltration and blood pressure. Dialysis complications were low in both periods. The percentage of cramps and hypotension requiring intervention was higher in the hyponatremic period with no statistically significant differences. Concerning thirst, there was a symptomatic improvement with sodium customization. This improvement was even more significant in the hyponatremic period. This study allowed us to reinforce the existence of a “sodium setpoint” for each patient and the importance of an individualized dialysis prescription. Our results suggest the safety of using isonatremic hemodialysis with improving patients’ symptoms. Regarding hyponatremic hemodialysis, despite being beneficial, it seemed to be associated with a higher number of complications.

scholarly journals How Would You Prescribe the Dialysate Sodium Concentration for Your Patients?

2021 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Friedrich K. Port
Keyword(s):  
Blood Pressure ◽  
Recent Trend ◽  
Sodium Concentration ◽  
Intradialytic Hypotension ◽  
Sodium Removal ◽  
Low Sodium ◽  
Interdialytic Weight Gain ◽  
Increased Risk ◽  
Dialysate Sodium ◽  
Intradialytic Symptoms

Low sodium dialysate was commonly used in the early year of hemodialysis to enhance diffusive sodium removal beyond its convective removal by ultrafiltration. However, disequilibrium syndrome was common, particularly when dialysis sessions were reduced to 4 h. The recent trend of lowering the DNa from the most common level of 140 mEq/L has been associated with intradialytic hypotension and increased risk of hospitalization and mortality. Higher DNa also has disadvantages, such as higher blood pressure and greater interdialytic weight gain, likely due to increased thirst. My assessment of the evidence leads me to choose DNa at the 140 level for most patients and to avoid DNa below 138. Patients with intradialytic symptoms may benefit from DNa 142 mEq/L, if they can avoid excessive fluid weight gains.

scholarly journals Effect of dialysate sodium concentration on interdialytic weight gain in hemodialysis patients

2021 ◽  
Vol 3 (2) ◽  
pp. 107-111
Author(s):  
Dr. Spandana Vuyyuru ◽  
Dr. K Vara Prasada Rao ◽  
Dr. Moturu Venkata Viswanath ◽  
Dr. Praveen Kumar Kolla ◽  
Dr. Raghavendra Sadineni
Keyword(s):  
Weight Gain ◽  
Sodium Concentration ◽  
Hemodialysis Patients ◽  
Interdialytic Weight Gain ◽  
Dialysate Sodium
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