Are Serum to Dialysate Sodium Gradient and Segmental Bioimpedance Volumes associated with the Fall in Blood Pressure with Hemodialysis?

Kumar, Sanjeev; Khosravi, Maryam; Massart, Annick; Potluri, Madhu; Davenport, Andrew

doi:10.5301/ijao.5000290

Cited by 20 publications

(16 citation statements)

References 34 publications

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“…Our findings are consistent with the current literature demonstrating a positive correlation between the sodium gradient and parameters of fluid overload in hemodialysis patients [15, 16, 19–21, 23, 27, 28]. These associations of a high sodium gradient with fluid overload are likely explained by a high dialysate sodium concentration leading to an elevated postdialysis serum sodium level with the consequence of increased thirst and fluid intake [29].…”

Section: Discussionsupporting

confidence: 92%

The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload

Trinh

Weber²

2017

Nephron Extra

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Background: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate the 6-month risk of hospitalization and mortality in relation to sodium gradient. Methods: We performed a cross-sectional study of 110 prevalent conventional hemodialysis patients at a single center. The associations of sodium gradient with interdialytic weight gain index (IDWG%), ultrafiltration (UF) rate, and blood pressure (BP) were analyzed. Results: The mean serum sodium gradient was 4.6 ± 3.6 mEq/L. There was a direct correlation between sodium gradient and IDWG% (r = 0.48, p < 0.01) as well as UF rate (r = 0.44, p < 0.01). In a logistic regression model, a 1 mEq/L higher sodium gradient was associated with increased risk of IDWG% >3% (OR 1.33, p < 0.01) and increased risk of UF rate >10 mL/kg/h (OR 1.16, p = 0.03), but there were no associations with intradialytic hypotension, intradialytic hypertension or BP. No significant differences were found with 6-month hospitalization or mortality risk in relation to sodium gradient. Conclusion: A higher sodium gradient was associated with significant increases in IDWG and UF rates, known to be associated with poor outcomes, but was not associated with intradialytic hypotension. Individualizing the dialysate sodium prescription to minimize sodium gap may lead to less fluid overload in conventional hemodialysis patients.

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Section: Discussionsupporting

confidence: 92%

The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload

Trinh

Weber²

2017

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“…The median follow-up was 19 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) months. During the first 12 months, 77 patients died (11%) and 55 were transplanted (8.3%).…”

Section: Resultsmentioning

confidence: 99%

“…An earlier study reported that intradialytic hypotension was a major difference between those who required time to recover postdialysis compared to those who needed no recovery time, 9 and greater cardiovascular stability during HD has been reported to reduce recovery time. 5,25 We only recorded the predialysis and postdialysis blood pressures of a single dialysis session, at the time of the questionnaire. We accept that changes in blood pressure may vary during the dialysis week, and from week to week.…”

Section: Discussionmentioning

confidence: 99%

Postdialysis recovery time is extended in patients with greater self‐reported depression screening questionnaire scores

Davenport

Guirguis

Almond

et al. 2018

Hemodialysis International

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“…However, IDH is probably multifactorial. Unfortunately, available data precluded study of the effects of dialysis sodium concentration and dialysate temperature, both of which may also affect IDH (21). Furthermore, prior studies indicate that fluid status with respect to extracellular euvolemia may be an important determinant in IDH (22,23).…”

Section: Discussionmentioning

confidence: 99%

Intradialytic Hypotension and Risk of Cardiovascular Disease

Stefánsson

Brunelli

Cabrera

et al. 2014

Clinical Journal of the American Society of Nephrology

265

192

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Background and objectives Patients undergoing hemodialysis have an elevated risk of cardiovascular diseaserelated morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role.

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Are Serum to Dialysate Sodium Gradient and Segmental Bioimpedance Volumes associated with the Fall in Blood Pressure with Hemodialysis?

Cited by 20 publications

References 34 publications

The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload

The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload

Postdialysis recovery time is extended in patients with greater self‐reported depression screening questionnaire scores

Intradialytic Hypotension and Risk of Cardiovascular Disease

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