Low dialysate sodium levels for chronic haemodialysis

Dunlop, Joanna; Vandal, Alain C.; Marshall, Mark R.

doi:10.1002/14651858.cd011204.pub2

Cited by 37 publications

(48 citation statements)

References 133 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prospective studies suggest that use of lower dialysate sodium is associated with lower IDWG and BP 90,91 but also show an association with intradialytic hypotension and symptoms, including cramps. 92 Observational studies have yielded mixed results regarding the association of dialysate sodium and mortality. [93][94][95] The Sodium Lowering in Dialysate (SoLID) RCT 96,97 assesses the effects of low versus standard dialysate sodium concentration on regression of left ventricular mass, with results pending.…”

Section: Intradialytic Hypotension and The Hd Prescriptionmentioning

confidence: 99%

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Flythe¹,

Chang²,

Gallagher³

et al. 2020

Kidney International

175

163

View full text Add to dashboard Cite

show abstract

Section: Intradialytic Hypotension and The Hd Prescriptionmentioning

confidence: 99%

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Flythe¹,

Chang²,

Gallagher³

et al. 2020

Kidney International

175

163

View full text Add to dashboard Cite

show abstract

“…However, the random allocation of treatment periods should have attenuated this bias due to temporal fluctuations in diet. The ideal DNa remains controversial [23]. In a general HD population, dialyzing with lower sodium concentrations has been reported as a safe technique [7].…”

Section: Discussionmentioning

confidence: 99%

Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

Robberechts¹,

Allamani²,

Galloo³

et al. 2020

OJNeph

View full text Add to dashboard Cite

Background. Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre-to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. Methods. We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L; period 2 and 4 with iso-or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. Results. Isonatremic and hyponatremic dialysate were associated with significantly lower pre-and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure; postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. Conclusion. Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre-and post-dialysis blood pressure in patients with intradialytic How to cite this paper: Robberechts, T.,

show abstract

“…Against this background, one of the most accepted surrogate markers of CV risk is left ventricular (LV) hypertrophy 14‐17 . One of the strongest predictors of LV mass is fluid overload, and one of the axiomatic causes of fluid overload is salt loading either through dialysate, diet, and/or inadequate ultrafiltration 4 . The possibility that lower dialysate [Na + ] might benefit LV mass has been studied in two recent and randomized clinical trials 9,18 .…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Recently, there has been renewed interest in lower dialysate [Na + ] as a means for controlling fluid volume, supported by positive qualitative and quantitative reviews of cumulative clinical experience. 4,5 This has provided a much needed evidence base to support the various "calls to action" from clinical governance groups that have made specific clinical recommendations in this area. Nonetheless, de-…”

Section: Introductionmentioning

confidence: 99%

Temporal changes in dialysate [Na⁺] prescription from 1996 to 2018 and their clinical significance as judged from a meta‐regression of clinical trials

Marshall

Karaboyas

2020

Seminars in Dialysis

View full text Add to dashboard Cite

Over the last two decades, the clinical care of dialysis patients has refocused sharply on fluid volume control. Dialysate [Na+] is a key, albeit under‐investigated, clinical tool for manipulation of fluid volume on dialysis. In the article, we firstly use data from the Dialysis Outcomes and Practice Patterns Study to document the global decrease in dialysate [Na+] that has occurred from 1996 to 2018, and demonstrate the virtual disappearance of [Na+] profiling from routine dialysis practice over the same period. Second, we used data from previously synthesized randomized clinical trial evidence combined with that of a more recently published trail to assess the clinical significance of these changes, estimating the effects of different levels of low dialysate [Na+] on key clinical outcomes. Our analyses suggest that current levels of dialysate [Na+] in some health jurisdictions are possibly causing harm to many patients, especially given that real world populations are significantly less robust and more vulnerable than clinical trial ones. To quote a recent editorial, “more evidence needed before lower dialysate sodium concentrations can be recommended.” That evidence is coming, and no further changes should be made to default customary practice until it is available.

show abstract

Low dialysate sodium levels for chronic haemodialysis

Abstract: Low dialysate sodium levels for chronic haemodialysis.

Cited by 37 publications

References 133 publications

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

Temporal changes in dialysate [Na⁺] prescription from 1996 to 2018 and their clinical significance as judged from a meta‐regression of clinical trials

Contact Info

Product

Resources

About

Low dialysate sodium levels for chronic haemodialysis

Abstract: Low dialysate sodium levels for chronic haemodialysis.

Cited by 37 publications

References 133 publications

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

Temporal changes in dialysate [Na+] prescription from 1996 to 2018 and their clinical significance as judged from a meta‐regression of clinical trials

Contact Info

Product

Resources

About

Temporal changes in dialysate [Na⁺] prescription from 1996 to 2018 and their clinical significance as judged from a meta‐regression of clinical trials