Effects of Increasing Diffusive Sodium Removal on Blood Pressure Control in Hemodialysis Patients with Optimal Dry Weight

Zhou, Yilun; Liu, Jing; Ma, Li; Sun, Fang; Shen, Yang; Huang, Jing; Cui, Tai-Gen

doi:10.1159/000346631

Cited by 23 publications

(23 citation statements)

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“…Thein et al reported dialysate sodium concentration reduction improved BP control without changes in IDWG. Our previous study found that increased sodium removal caused both ambulatory and home BP reduction in 16 HD patients without volume overload . However, all these studies only mentioned BP parameters without influences on BPV.…”

Section: Discussionmentioning

confidence: 99%

“…We chose the duration of the 8‐week period based on our previous study suggesting that patients’ systolic and diastolic home BPs were slightly lower by the end of month 1, attained statistical significance by the end of month 2, and remained at a steady status by months 3 and 4 when the dialysate sodium concentration was decreased from 138 to 136 mmol/L. …”

Section: Methodsmentioning

confidence: 99%

“…One of the most important goals of the dialysis therapy is to remove the mass of sodium that has been accumulated in the interdialysis period exactly. It has been reported that increasing sodium removal by lowering dialysate sodium concentration resulted in decreases in BP and IDWG . In addition, our previous study showed that lowering dialysate sodium concentration was associated with improvements in arterial stiffness and LVH in hypertensive HD patients .…”

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Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients

et al. 2018

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Blood pressure variability is an independent risk factor for mortality and cardiovascular events in hemodialysis patients. Dialysate sodium concentration may not only have effects on blood pressure but also on blood pressure variability. We investigated whether dialysate sodium concentration lowering could decrease home blood pressure variability in hemodialysis patients. Forty‐three hemodialysis patients at their dry weight assessed by bioimpedance methods with pre‐dialysis serum sodium >136 mmol/L were recruited. Firstly, patients underwent a 1‐month standard dialysis with dialysate sodium concentration of 138 mmol/L, and then the dialysate sodium concentration was decreased to 136 mmol/L for 8 weeks. Home blood pressure was assessed on waking up and at bedtime for 1 week. Coefficient of variation was used to define home blood pressure variability. After the intervention, whole‐day systolic blood pressure variability decreased from 5.7 ± 2.6% to 4.3 ± 1.7% and evening systolic blood pressure variability decreased from 7.9 ± 4.1% to 6.2 ± 3.1%. Morning systolic blood pressure variability had a reduction from 7.8 ± 2.4% to 5.9 ± 3.3% but did not achieve statistical significance (P = 0.077). Whole‐day, morning and evening systolic blood pressure were decreased significantly. Less changes were observed in diastolic blood pressure parameters. Interdialytic weight gain mildly but significantly decreased. Volume parameters, dietary sodium intake and incidence of adverse events were similar throughout the study period. Lowering dialysate sodium concentration could improve home blood pressure variability among hemodialysis patients who had achieved their dry weight.

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confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients

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“…Home BP and heart rate measurement was performed on waking up and at bedtime for 1 week with the self‐inflating automatic oscillometric device (HEM 7052 or 7112; Omron Healthcare, Kyoto, Japan). Such a device has worked well in our previous studies . Patients were asked to record their BP readings on a provided data sheet.…”

Section: Methodsmentioning

confidence: 99%

Effect of Improving Volume Overload on Home Blood Pressure Variability in Hemodialysis Patients

et al. 2019

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Blood pressure variability is an independent predictor of adverse clinical events in hemodialysis patients. Volume overload is one of the most important factors affecting blood pressure homeostasis. In the present study, we explored the effects of dry weight reduction on home blood pressure variability in volume overload hemodialysis patients. Hemodialysis patients with volume overload had their dry weight gradually decreased under the guidance of bioimpedance methods, which was represented by calf‐bioimpedance ratio (Calf‐BR). Home blood pressure was measured on waking up and at bedtime for 1 week at baseline and at the end of the two‐month study. Coefficient of variation was used to define home blood pressure variability. Thirty‐eight hemodialysis patients had their dry weight significantly decreased from 60.7 ± 11.3 to 59.6 ± 10.7 kg (P = 0.003) accompanied with a significant reduction in calf‐BR (0.828 ± 0.023 vs. 0.786 ± 0.020, P<0.001). The systolic and diastolic blood pressure decreased significantly. Moreover, the whole‐day, morning, and evening systolic blood pressure variability gradually and significantly decreased by the end of the study (5.6 ± 2.1% versus 4.0 ± 1.7%, P<0.001; 7.7 ± 3.5% vs. 6.3 ± 2.7%, P = 0.005; 7.5 ± 2.8% vs. 5.9 ± 2.3%, P = 0.002, respectively). Diastolic blood pressure variability parameters were unchanged. The interdialytic weight gain and the incidence of adverse events were similar throughout the study period. Gradual dry weight reduction by bioimpedance methods improved home blood pressure variability in hemodialysis patients with chronic fluid overload.

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“…Uncontrolled hypertension in CKD patients is characterized by water and sodium retention and increased blood volume. A study of patients who underwent hemodialysis treatment revealed that blood pressure was further reduced in low dialysis sodium concentrations and even in patients who have reached their dry weight [13]. Therefore, the use of diuretics is considered reasonable in controlling CKD hypertension.…”

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Hypertension in patients with CKD in China: clinical characteristics and management

Cai

Chen

2017

Front. Med.

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Chronic kidney disease (CKD) is a life-threatening disease that results in end-stage renal disease (ESRD) and consumes substantial health resources. In China, the prevalence of CKD in the general population is 10.8% and increases gradually with age [1]. CKD also causes hypertension. The prevalence of hypertension in the general population is 25.2% [2], and the prevalence of hypertension with CKD is much higher. From 2010 to 2011, a national epidemiological survey of CKD in hospitalized patients (PATRIOTIC study) showed that the prevalence of renal hypertension was 67.3% [3]. Another study from 2012 to 2013 indicated that the prevalence of hypertension in CKD patients was 71.2% [4], suggesting the elevating prevalence of renal hypertension.The PATRIOTIC study was a multi-center epidemiological survey, which included 61 hospitals in China. The results showed that the prevalence of renal hypertension in the elderly was 82.0%, significantly higher than that of young patients with CKD. The prevalence rates of hypertension in the elderly CKD groups aged 60-69 years, 70-79 years, and over 80 years old were 81.2%, 82.6%, and 84.5%, respectively, indicating that the older the age, the higher the prevalence rate. As eGFR falls, the prevalence rate of hypertension increases [5]. Compared with those in CKD stage 1, the prevalence rate of patients in CKD stages 3b, 4, and 5 rises significantly [6].Although the prevalence of renal hypertension remains high, awareness and treatment rate have been improved in recent years. The awareness and treatment rate of renal hypertension in the survey from 1999 to 2002 were 75.7% and 80.4% [7], respectively, which rose to 95.4% and 93.7% in the survey from 2012 to 2013 [4]. These findings suggested the dramatic improvement of the condition. Nevertheless, a survey from hospitalized patients with CKD showed that 4.6% had no knowledge of hypertension. The awareness of renal hypertension in the community was likely much lower. A telephone survey conducted in Hong Kong for the general population revealed that 43.6% of the subjects did not understand the importance of blood pressure measurement in CKD, and more than 60% were unaware that hypertension is a complication of CKD [8]. This finding indicates that efforts on the publicity, prevention, and control of hypertension in the community need to be further improved.Improving the management of hypertension plays an important role in delaying renal disease progression and complications, as well as enhances the prognosis of CKD patients. To promote hypertension management, a number of guidelines for prevention and treatment were developed, among which the Kidney Disease: Improving Global Outcomes (KDIGO) Guideline (2012) and the United States NKF KDOQI (2004) were the most influential [9,10]. The Chinese Nephrologist Association initiated and completed the Chinese Guidelines for the Management of Hypertension in CKD (2016), hoping to guide clinical practice and improve awareness, diagnosis, and treatment of hypertension in CKD in China. The KDI...

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Effects of Increasing Diffusive Sodium Removal on Blood Pressure Control in Hemodialysis Patients with Optimal Dry Weight

Cited by 23 publications

References 30 publications

Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients

Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients

Effect of Improving Volume Overload on Home Blood Pressure Variability in Hemodialysis Patients

Hypertension in patients with CKD in China: clinical characteristics and management

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