Effects of lowering dialysate sodium on flow-mediated dilatation in patients with chronic kidney disease

Kutlugun, Aysun Aybal; Erdem, Yunus; Okutucu, Sercan; Yorgun, Hikmet; Atalar, Enver; Arıcı, Mustafa

doi:10.1093/ndt/gfr092

Cited by 29 publications

(26 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The disruption of BP homeostasis can be reflected by elevated BPV and may be due to the impairment of endothelial or cardiovascular function, or decreased compliance of elastic arteries that stem from arterial stiffness. In line with this finding, a study that lowered dialysate sodium concentration from 143 to 137 mmol/L did improve endothelial dysfunction as measured by flow‐mediated dilatation in HD patients . Our previous study, using a similar sodium gradient with the present study, showed that arterial stiffness, assessed by aortic pulse wave velocity, and LVH were improved at the end of 1‐year dialysate sodium concentration lowering .…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 91%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Mechanistically, the high sodium gradient might increase blood pressure by increasing body fluid volume during the session but might also have a more complex basis (eg, endothelial dysfunction) as suggested earlier . It is also important to acknowledge that there are, as with many areas of investigation, several contrary studies that found no blood pressure lowering effect of low DNa …”

Section: Clinical Effects Of Dialysis Sodium Concentrationmentioning

confidence: 91%

Dialysate sodium concentration: The forgotten salt shaker

Hanafusa

Tsuchiya

Nitta

2018

Seminars in Dialysis

View full text Add to dashboard Cite

The concentration of sodium in dialysis fluid, a major determinant of extracellular fluid volume and blood pressure, plays a major role in the sodium balance in end‐stage renal disease patients. A low dialysate sodium concentration (DNa) reduces interdialytic weight gain (IDWG) and blood pressure and might help ameliorate endothelial dysfunction and inflammation. However, low DNa can also increase the incidence of hypotensive episodes and muscle cramps. Sodium profiling, as typically prescribed in which the DNa is ramped up from above 140 mEq/L to nonphysiological levels, might reduce hypotension in patients with hemodynamic instability but at the cost of the consequences of hypernatremia. Serum sodium concentrations of individual patients fall within a narrow range around a “sodium setpoint.” The sodium gradient, the difference between the sodium set point and the DNa, is associated more robustly with clinical outcomes than DNa itself. Sodium concentration presents several issues: the influence of the net negative charge of plasma proteins on sodium flux across the dialysis membrane (Donnan equilibrium); and the clinically important problems in measuring sodium levels. This article presents a review of the clinical effects of DNa and of basic aspects of sodium balance in hemodialysis patients.

show abstract

“…Again, some studies observed that choosing a lower dialysate sodium (134 to <140 mEq/L) was associated with more episodes of intradialytic hypotension and cramps and longer time to recover post‐dialysis, whereas many other studies have reported no significant differences in intradialytic events …”

Section: Introductionmentioning

confidence: 99%

Why does the choice of dialysate sodium concentration remain controversial?

Tangvoraphonkchai

Davenport

2018

Hemodialysis International

View full text Add to dashboard Cite

The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration. Although most studies have reported a reduction in IDWG with lower dialysate sodium concentrations, the effects on blood pressure control, and adverse intradialytic events have been variable. Different outcomes between studies may be partially explained by patient selection, with differences in dietary sodium intake, urinary sodium losses, and sodium stores in the body. In addition, multicenter trials potentially introduce additional confounders, including differences in local quality control of delivered dialysate sodium concentration and sodium measurements. Although there may be advantages for lower dialysate sodium concentration, observational studies have reported a survival advantage for higher dialysate sodium concentrations for those patients with lower serum sodium concentrations pre-dialysis. As there is no current consensus for a universal dialysate sodium concentration, attention has turned to considering an individualized approach to choosing a dialysate sodium concentration.

show abstract

Effects of lowering dialysate sodium on flow-mediated dilatation in patients with chronic kidney disease

Abstract: Reducing dialysate sodium concentration reduced ED, and provided better control of IDWG and BP, but increased dialysis-related symptoms.

Cited by 29 publications

References 40 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

Dialysate sodium concentration: The forgotten salt shaker

Why does the choice of dialysate sodium concentration remain controversial?

Contact Info

Product

Resources

About