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

Chen, Ziye; Sun, Fang; Shen, Yang; Ma, Li; Liu, Jing; Zhou, Yilun

doi:10.1111/1744-9987.12771

Cited by 4 publications

(5 citation statements)

References 35 publications

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“…An important issue to consider is that the reduction in dialysate bicarbonate concentration increased conductivity from 14 to 14.1 mS/cm (while dialysate sodium remained unchanged at 140 mEq/L) due to the concentrate proportioning in the dialysis machine. As previously reported, high conductivities based on high dialysate sodium prescriptions increase blood pressure [ 26 ], water intake [ 27 ] and interdialysis weight gain [ 28 ]. Therefore, as presented in Table 1 , to avoid increasing conductivity when we reduced dialysate bicarbonate, we decreased the sodium concentration in the dialysate from 140 to 139 mEq/L, achieving again a conductivity of 14.0 mS/cm.…”

Section: Discussionmentioning

confidence: 89%

Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration

Broseta

Rodríguez-Espinosa

Lidia

et al. 2020

Clinical Kidney Journal

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Background Metabolic acidosis is a common problem in haemodialysis patients, but acidosis overcorrection has been associated with higher mortality. There is no clear definition of the optimal serum bicarbonate target or dialysate bicarbonate. This study analysed the impact of reducing dialysate bicarbonate from 35 to 32 mEq/L on plasma bicarbonate levels in a cohort of patients treated with online haemodiafiltration (OL-HDF). Methods We performed a prospective cohort study with patients in a stable chronic OL-HDF programme for at least 12 months in the Hospital Clinic of Barcelona. We analysed pre- and post-dialysis total carbon dioxide(TCO2) before and after dialysate bicarbonate reduction from 35 to 32 mEq/L, as well as the number of patients with a pre- and post-dialysis TCO2 within 19–25 and ≤29 mEq/L, respectively, after the bicarbonate modification. Changes in serum sodium, potassium, calcium, phosphorous and parathyroid hormone (PTH) were also assessed. Results We included 84 patients with a 6-month follow-up. At 6 months, pre- and post-dialysis TCO2 significantly decreased (26.78 ± 1.26 at baseline to 23.69 ± 1.92 mEq/L and 31.91 ± 0.91 to 27.58 ± 1.36 mEq/L, respectively). The number of patients with a pre-dialysis TCO2 >25 mEq/L was significantly reduced from 80 (90.5%) to 17 (20.2%) and for post-dialysis TCO2 >29 mEq/L this number was reduced from 83 (98.8%) to 9 (10.7%). PTH significantly decreased from 226.09 (range 172–296) to 182.50 (125–239) pg/mL at 6 months (P < 0.05) and post-dialysis potassium decreased from 3.16 ± 0.30 to 2.95 ± 0.48 mEq/L at 6 months (P < 0.05). Sodium, pre-dialysis potassium, calcium and phosphorous did not change significantly. Conclusions Reducing dialysate bicarbonate concentration by 3 mEq/L significantly and safely decreased pre- and post-dialysis TCO2, avoiding acidosis overcorrection and improving secondary hyperparathyroidism control. An individualized bicarbonate prescription (a key factor in the adequate control of acidosis) according to pre-dialysis TCO2 is suggested based on these results.

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Section: Discussionmentioning

confidence: 89%

Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration

Broseta

Rodríguez-Espinosa

Lidia

et al. 2020

Clinical Kidney Journal

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“…The relationship of BPV with all-cause mortality and cardiovascular events in HD patients has raised the concerns about how to decrease BPV in this population (4,26). Previously, we have shown that home BPV was decreased by lowering dialysate sodium concentration in HD patients without volume overload (17). The present study provided new information about the effect of decreasing DW under the guidance of BIS measurement on home BPV in HD patients with volume overload.…”

Section: Discussionmentioning

confidence: 59%

“…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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“…LVH could be mediated by sodium retention through hypertension, increased intravascular volume, increased afterload and cardiac traction. We found the risk of LVH was increased in patients with serum sodium ≥ 138 mmol/L in our study, which is our median value of sodium level and also a well-used cut off value to assess prognosis [ 32 – 34 ]. Our finding is consistent with former study [ 34 ].…”

Section: Discussionmentioning

confidence: 74%

“…We found the risk of LVH was increased in patients with serum sodium ≥ 138 mmol/L in our study, which is our median value of sodium level and also a well-used cut off value to assess prognosis [ 32 – 34 ]. Our finding is consistent with former study [ 34 ]. Moreover, scholars suggest that adjusting dialysate sodium concentration might be a simple method to ameliorate sodium retention for HD patients.…”

Section: Discussionmentioning

confidence: 74%

Echocardiographic left ventricular hypertrophy and geometry in Chinese chronic hemodialysis patients: the prevalence and determinants

Zhao

Zhu

Jin

et al. 2022

BMC Cardiovasc Disord

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Background To investigate the prevalence of left ventricular hypertrophy (LVH) and explore left ventricular geometry in maintenance hemodialysis (MHD) patients, and to explore the risk factors of LVH which is an important predictor of cardiovascular events. Methods The subjects were patients who are on MHD for more than 3 months in Peking University People's Hospital from March 2015 to February 2017. Demographic and clinical data were retrospectively collected. Left ventricular mass was measured by echocardiography. LVH is defined by Left ventricular mass index (LVMI) > 115 g/m2 for men and > 95 g/m2 in women. LVMI and relative wall thickness were used to determine left ventricular geometry. Logistic regression was used to analyze the risk factors of LVH. Results Altogether, 131 patients including 77 males were enrolled. The median age was 60 (47, 69) years, with a median dialysis vintage of 48 (18, 104) months. There were 80 patients with LVH, the prevalence rate was 61.1%, and 66.3% of them were moderate to severe LVH. We found that (1) most of the patients were concentric hypertrophy; (2) one-third of the patients were concentric remodeling; (3) only 4 cases with normal geometry. The pre-dialysis serum sodium level and time average pre-dialysis systolic blood pressure (SBP) were independent risk factors of LVH. Conclusion LVH is prevalent in MHD patients. Concentric hypertrophy and concentric remodeling are the most common geometric patterns. Attention should be paid to long-term pre-dialysis SBP management and pre-dialysis sodium control as they might be potentially modifiable risk factors for LVH.

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

Cited by 4 publications

References 35 publications

Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration

Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration

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

Echocardiographic left ventricular hypertrophy and geometry in Chinese chronic hemodialysis patients: the prevalence and determinants

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