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 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.

Evidence of Profiled Hemodialysis Efficacy in the Treatment of Intradialytic Hypotension

1998 ◽  
Vol 21 (7) ◽  
pp. 398-402 ◽  
Author(s):  
L. Colì ◽  
G. La Manna ◽  
V. Dalmastri ◽  
A. De Pascalis ◽  
G. Pace ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Volume ◽  
Sodium Concentration ◽  
Dialysis Session ◽  
Intradialytic Hypotension ◽  
Dialysis Patients ◽  
Non Invasive ◽  
Comparison Of The Results ◽  
Weight Decrease ◽  
Dialysate Sodium

In the last 10 years the percentage of dialysis patients suffering from clinical intradialytic intolerance has greatly increased. Profiled hemodialysis (PHD) is a new technical approach, alternative to standard hemodialysis (SHD) for the treatment of intradialytic symptomatic hypotension. It is based on intradialytic modulation of the dialysate sodium concentration, using a dialysate sodium concentration profile elaborated by a new mathematical kinetic model. The aim of PHD is to reduce the intradialytic blood volume decrease, thanks to a dialysate sodium profile, which allows a reduction in the plasma osmolarity decrease, thereby boosting intravascular fluid refilling. This work aims at clinically validating the PHD technique, by testing its ability, against SHD, to maintain a more stable intradialytic blood volume; this evaluation was supported by monitoring some hemodynamic parameters. Twelve dialysis patients on SHD treatment were selected because of their intradialytic symptomatic hypotension. Twelve SHD (one per patient) and 12 PHD sessions (one per patient) were performed to achieve the same sodium mass removal and body weight decrease on both PHD and SHD. During these sessions we monitored the blood volume variation % by the critline (a non invasive blood volume monitoring device), the mean blood pressure and heart rate directly and, finally, the stroke volume and cardiac output indirectly by bidimensional doppler-echocardiography. Comparison of the results obtained with the two techniques shows PHD to achieve a significantly more stable blood volume, blood pressure and cardiovascular function than SHD, in particular during the second and the third hour of the dialysis session.

MO717EFFECT ON BLOOD PRESSURE OF UNCOMPENSATED 130 MM SODIUM DIALYSATE IN CAPD PATIENT WITH RESISTANT HYPERTENSION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Silvio Borrelli ◽  
Mario Bonomini ◽  
Arduino Arduini ◽  
Roberto Palumbo ◽  
Luigi Vecchi
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Resistant Hypertension ◽  
Sodium Concentration ◽  
Sodium Retention ◽  
Sodium Removal ◽  
Low Sodium ◽  
Ambulatory Bp Monitoring ◽  
Residual Diuresis ◽  
Capd Patient

Abstract Background and Aims In peritoneal dialysis (PD) blood pressure (BP) control is largely unsatisfied mainly due to sodium retention. Currently, sodium removal in PD patients depends substantially on ultrafiltration. Lowering sodium in PD solution might improve sodium removal by diffusion, though the real benefit of low PD solution remains still undetermined. Method In this case report, we used a novel uncompensated glucose-based PD solution (DextroCore LS, Iperboreal Pharma, Italy) containing 130 mM sodium to treat resistant hypertension in 78-year-old female treated by CAPD (3 dwells glucose 1.5% a day, Na 132). Results At baseline, Ambulatory BP monitoring (ABPM) showed 24h-BP (152/81 mmHg), diurnal BP (151/83 mmHg) and nocturnal BP (153/75 mmHg), with inversion of circadian rhythm in systolic BP (systolic night/day ratio: 1.02), despite the use of three anti-hypertensive (doxazosin 4mg, amlodipine 10 mg, telmisartan 80 mg) and diuretic (furosemide 250 mg) at adequate doses. She had no signs of hypervolemia. We switched from standard PD (132 mM/L) to low sodium PD solution using 1.5% glucose bags with sodium concentration of 130 mM. CAPD schedule was confirmed. Second ABPM after six months reported a reduction 24h BP (131/73 mmHg), diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), with restoring of circadian BP rhythm. No change in body weight, UF and residual diuresis was found. Diet and therapy prescriptions were unmodified. No side effects were reported. Conclusion Six-months PD treatment with uncompensated glucose-based PD solution containing 130 mM sodium in all daily dwells has allowed to reduce systolic BP (-16 mmHg) in a CAPD patient affected by resistant hypertension, with no change in ultrafiltration and residual diuresis.

scholarly journals Clinical Effects of Standard and Individualized Dialysate Sodium in Patients on Maintenance Hemodialysis

2016 ◽  
Vol 4 (2) ◽  
pp. 248-252 ◽  
Author(s):  
Natasa Eftimovska–Otovic ◽  
Olivera Stojceva-Taneva ◽  
Risto Grozdanovski ◽  
Saso Stojcev
Keyword(s):  
Blood Pressure ◽  
Sodium Concentration ◽  
The Other ◽  
Second Phase ◽  
Clinical Effects ◽  
Hypertensive Patients ◽  
Muscle Cramps ◽  
Interdialytic Weight Gain ◽  
Set Up ◽  
Dialysate Sodium

BACKGROUND: The degree to which the dialysate prescription and, in particular, the dialysate sodium concentration influences blood pressure and interdialytic weight gain (IDWG) via changes in sodium flux, plasma volume or the other parameters is not well understood. 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 or sodium modeling.MATERIAL AND METHODS: Ninety-two nondiabetic subjects (52 men and 40 women) performed 12 consecutive hemodialysis (HD) sessions (4 weeks) with dialysate sodium concentration set up on 138 mmol/L (standard sodium – first phase), followed by 24 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic and mean blood pressure, pulse, IDWG, thirst score – (Xerostomia Inventory (XI) and Dialysis Thirst Inventory (DTI)) and side effects (occurrence of hypotension and muscle cramps). After the first phase, the subjects were divided into 3 groups: normotensive (N=76), hypertensive (N= 11) and hypotensive (N=5) based on the average pre-HD systolic BP during the whole period of the first phase.RESULTS: Sodium individualization 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). Sodium profiling in hypotensive patients significantly increased IDWG (2.45 vs. 2.74, p= 0,006), and had no impact on blood pressure. Thirst score was significantly lower in normotensive patients with individualized-sodium HD and showed no change in the other two groups. During the second phase, hypotension occurred in only 1 case and muscle cramps in 10 normotensive patients.CONCLUSION: Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients.

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.

scholarly journals Effects of sertraline in the prevention of low blood pressure in patients undergoing hemodialysis

2019 ◽  
Vol 41 (4) ◽  
pp. 492-500
Author(s):  
Christine Zomer Zomer Dal Molin ◽  
Thiago Mamoru Sakae ◽  
Fabiana Schuelter-Trevisol ◽  
Daisson Jose Trevisol
Keyword(s):  
Blood Pressure ◽  
Placebo Group ◽  
Major Complication ◽  
Number Needed To Treat ◽  
Intradialytic Hypotension ◽  
Double Blind ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Two Phases ◽  
Intradialytic Symptoms

Abstract Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality. Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients. Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension. Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms. Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.

scholarly journals FP538EFFECTS OF PRESCRIBING DIFFERENT DIALYSATE SODIUM CONCENTRATION ON BLOOD PRESSURE AND LABORATORY PARAMETERS

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii252-iii253
Author(s):  
Natasa Eftimovska-Otovic ◽  
Risto Grozdanovski ◽  
Olivera Stojceva-Taneva
Keyword(s):  
Blood Pressure ◽  
Sodium Concentration ◽  
Laboratory Parameters ◽  
Dialysate Sodium
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