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

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.

MO843PREVALENCE AND MANAGEMENT OF HYPERTENSION IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ali AlSahow ◽  
Anas Alyousef ◽  
Bassam Alhelal ◽  
Heba AlRajab ◽  
Yousif Bahbahani ◽  
...  
Keyword(s):  
Weight Gain ◽  
Fluid Intake ◽  
Salt Intake ◽  
Statistical Significance ◽  
Dry Weight ◽  
Weekly Schedule ◽  
Interdialytic Weight Gain ◽  
High Salt Intake ◽  
Number Of Patients ◽  
High Calcium

Abstract Background and Aims Hypertension (HTN) is common in hemodialysis (HD) patients & diagnosed by pre-dialysis BP >140/90 mmHg. Causes include high salt intake, volume overload, & loss of residual kidney function. Therapy includes achieving correct dry weight with each session, restricting interdialytic sodium & fluid intake & medications. We review its prevalence, factors associated with it & its management in our patients. Method Demographics, HD prescription & medications data collected for patients from 5 dialysis centers. Results A total of 1585 files reviewed. Males were 51.8% & mean age was 59. Mean age significantly higher for females (61 vs 57). ESKD cause was DM in 51% & HTN in 35%. However, of files reviewed, adequate data on comorbidities in 1390 patients (table 1), 69% had DM, 92% had HTN, 47% had CVD & 31% had BMI > 25 (which was significantly more frequent in females). HTN was more likely in older patients, diabetics & females with odds of HTN in females nearly twice the odds of HTN in males & odds of HTN with DM is 2.27 times odds of HTN without DM & one-year increase in age would increase odds of HTN by nearly 4%. Mean pre-HD BP for those with HTN was 143/76 mmHg & for those without HTN was 136/75 mmHg. HD frequency was thrice weekly in 94% & HD duration was > 3.5 hours in only 77% of patients. HDF used in 81.5%. Mean interdialytic weight gain (IDWG) was 2.8 kg, with no difference according to gender or presence of DM or HTN (Table 2). Higher IDWG associated with age < 65, Calcium bath of 1.75 & Sodium bath > 138 with 0.638 kg higher IDWG with calcium of 1.75 compared to calcium of 1.25. Higher IDWG was associated with higher BP. Mean volume of fluid removed per session was 2.74, which was less than mean IDWG, with no difference according to gender or DM, however, it was higher in the higher dialysate sodium group, & lower in the shorter session group (with trend towards statistical significance). CCB used to treat HTN in 62% followed by βB in 52%. Number of patients with HTN on 1 drug 21%, 2 drugs 27%, 3 drugs 23%, ≥ 4 drugs 20% & 9% missing data. Number of antihypertensives did not correlate with IDWG. Conclusion Interdialytic weight gain in our HD patients is excessive & contributing to HTN. Patients must restrict salt & fluid intake & dialysis centers must regularly & frequently assess dry weight, ensure thrice weekly schedule & 4 hours per session are met, so excess fluid is completely removed. Also, high sodium & high calcium baths need to be avoided.

scholarly journals Hubungan antara Interdialytic Weight Gain dengan Perubahan Tekanan Darah Intradialisis pada Pasien Chronic Kidney Diseases

2020 ◽  
Vol 3 (1) ◽  
pp. 32
Author(s):  
Ni Kadek Yuni Lestari ◽  
Ni Luh Gede Intan Saraswati Saraswati
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Kidney Diseases ◽  
Rank Statistic ◽  
P Value ◽  
Cross Sectional ◽  
Chronic Kidney Diseases ◽  
Purposive Sampling ◽  
Adherence To Diet ◽  
Interdialytic Weight Gain

Pasien CKD (Chronic Kidney Diseases) yang menjalani hemodialisis sering mengalami komplikasi gangguan hemodinamik baik itu hipertensi maupun hipotensi intradialisis. Salah satu penyebab yang paling sering adalah peningkatan IDWG (Interdialytic Weight Gain). Tujuan penelitian ini adalah untuk menganalisis hubungan antara IDWG (Interdialytic Weight Gain)dengan perubahan tekanan darah intradialisis pada pasien CKD di Ruang Hemodialisis RSUP Sanglah Denpasar. Metode penelitian yang digunakan adalah analitik korelasi dengan pendekatan cross sectional. Teknik sampel yang digunakan adalah purposive sampling dengan jumlah sampel sebanyak 80 responden. Analisis statistik dengan menggunakan spearmans rank. Hasil penelitian didapatkan dari 80 responden sebagian besar mempunyai interdialytic weight gain dalam kategori ringan (73,8,0%) dan tekanan darah intradialisis dalam batas normal (65,0%). Hasil uji statistik menunjukkan p value 0,001 (<0,05). Kesimpulan dari penelitian ini bahwa ada hubungan yang signifikan antara interdialytic weight gain dengan perubahan tekanan darah intradialisis pada pasien chronic kidney diseases di Ruang Hemodialisis RSUP Sanglah Denpasar. Berdasarkan hasil penelitian ini bahwa perawat diharapkan dapat meningkatkan pemberian edukasi secara berkala pada pasien hemodialisis reguler untuk meningkatkan kepatuhan pasien pada diet dan pembatasan intake cairan.Chronic Kidney Diseases (CKD) patients who undergo hemodialysis often experience complications of haemodynamic disorders, both hypertension and intradialisis hypotension. One of the most frequent causes of increasing is IDGW (Interdialytic Weight Gain). The purpose of this study was to determine the correlation between interdialytic weight gain and changes in intradialysis blood pressure among patients with chronic kidney diseases in Haemodialysis Roomat Sanglah Hospital Denpasar. The research method used is analytic correlation with cross sectional approach. The sample technique used was purposive sampling with a total sample of 80 respondents. Statistical analysis using spearmans rank statistic test. The results obtained from 80 respondents most mostly interdialytic weight gain in the mild category (73.8.0%) and intradialisis blood pressure within normal limits (65.0%). The result of statistic test shows that p value 0,001 (<0,05). The conclusion of this study is that any significant correlation between interdialytic weight gain with changes in intradialysis blood pressure among patients with CKD at Haemodialysis Room of Sanglah Hospital Denpasar. Suggestions for nurses to increase the provision of regular education in regular haemodialysis patients to improve patient’s adherence to diet and limit fluid intake.

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