The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis

Kayıkçıoğlu, Meral; Tümüklü, Murat; Özkahya, Mehmet; Özdoğan, Öner; Aşçı, Gülay; Duman, Soner; Töz, Hüseyin; Can, Levent; Başçı, Alı; Ok, Ercan

doi:10.1093/ndt/gfn599

Cited by 165 publications

(125 citation statements)

References 26 publications

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“…In 1969, Vertes et al reported that 35 of 40 patients became "normotensive" by achieving dry weight. 102 In a more recent report from 103 In a case-control study, patients who had been treated at one center with salt restriction and dry weight reduction were compared with patients at another center where antihypertensive-based therapy was the primary method for management of hypertension. The center using dry weight and salt restriction as a primary strategy had the following benefits: lower antihypertensive drug use (7% versus 42%), lower interdialytic weight gain, lower left ventricular mass, better diastolic and systolic left ventricular function, and fewer episodes of intradialytic hypotension.…”

Section: Benefits Of Probing Dry Weightmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

161

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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Section: Benefits Of Probing Dry Weightmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

161

156

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“…High IDWG is associated with hypertension (1), intradialytic hypotension (2), and adverse cardiovascular outcomes (3,4), including increased all-cause mortality (5). It is well accepted that the degree of IDWG is influenced by dietary sodium intake (6,7), and for this reason, guidelines suggest that individuals with CKD restrict dietary sodium intake (8,9). Studies of patients with CKD stage 5D suggest that restricting dietary sodium can improve left ventricular hypertrophy and reduce intradialytic hypotension (6,10).…”

Section: Introductionmentioning

confidence: 99%

“…It is well accepted that the degree of IDWG is influenced by dietary sodium intake (6,7), and for this reason, guidelines suggest that individuals with CKD restrict dietary sodium intake (8,9). Studies of patients with CKD stage 5D suggest that restricting dietary sodium can improve left ventricular hypertrophy and reduce intradialytic hypotension (6,10). Although a reduction in dietary intake of sodium is recommended as an important intervention for patients with CKD, the ubiquitous addition of table salt to processed foods in conjunction with many patients being at a socioeconomic disadvantage means that it is difficult for patients to maintain an effective reduction in dietary sodium intake.…”

Section: Introductionmentioning

confidence: 99%

Effect of Tenapanor on Interdialytic Weight Gain in Patients on Hemodialysis

Block

Rosenbaum

Leonsson-Zachrisson

et al. 2016

CJASN

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Background and objectives Interdialytic weight gain in patients on hemodialysis is associated with adverse cardiovascular outcomes and increased mortality. The degree of interdialytic weight gain is influenced by sodium intake. We evaluated the effects of tenapanor (AZD1722 and RDX5791), a minimally systemically available inhibitor of the sodium/hydrogen exchanger isoform 3, on interdialytic weight gain in patients with CKD stage 5D treated with hemodialysis.Design, setting, participants, & measurements This phase 2, randomized, double-blind study (NCT01764854; conducted January to September of 2013) enrolled adults on maintenance hemodialysis with interdialytic weight gain $3.0% of postdialysis weight and $2 kg. Patients were randomly assigned (1:1) to receive tenapanor or placebo. The primary end point was change in mean interdialytic weight gain (percentage of baseline postdialysis weight) from baseline (mean across a 2-week run-in period) to week 4. In a subgroup of inpatients, 24-hour stool sodium and stool weight were assessed for 1 week.Results Sixteen patients received 1 week of inpatient treatment (tenapanor, eight; placebo, eight), and 72 patients received 4 weeks of treatment in an outpatient setting (tenapanor, 37; placebo, 35; completers: tenapanor, 31; placebo, 33). In the outpatient cohort, no significant effect on interdialytic weight gain was detected; least squares mean changes in relative interdialytic weight gain from baseline to week 4 were tenapanor, 20.26% (95% confidence interval, 20.57% to 0.06%) and placebo, 20.23% (95% confidence interval, 20.54% to 0.07%; P=0.46). During week 1 (inpatient cohort only), compared with placebo, tenapanor treatment resulted in higher stool sodium content (mean [6SD]: tenapanor, 36.6 [621.8] mmol/d; placebo, 2.8 [62.7] mmol/d; P,0.001) and higher stool weight (tenapanor, 172.5 [668.1] g/d; placebo, 86.3 [630.0] g/d; P,0.01). A similar safety profile was observed across treatment groups with the exception of diarrhea, which occurred more frequently with tenapanor treatment.Conclusions Tenapanor treatment increased stool sodium and weight over placebo in patients undergoing hemodialysis. However, over 4 weeks of treatment, there was no difference in interdialytic weight gain between patients treated with tenapanor and those receiving placebo.

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“…This reduction in salt intake, on average 2.3 g/day, may have a beneficial effect in a population already fluid sensitive and prone to cardiovascular disease [18]. In our study, there was no change in the IDWG, BP medications, or BP during the follow-up period.…”

Section: Discussionmentioning

confidence: 43%

Sevelamer carbonate increases serum bicarbonate in pediatric dialysis patients

et al. 2010

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Sevelamer hydrochloride (HCl), a calcium-free phosphate binder, is increasingly used due to concerns related to calcium exposure and the development of vascular calcifications. However, a common side effect of sevelamer HCl, metabolic acidosis, is particularly concerning in children, as it can contribute to poor growth. Sevelamer carbonate is now available and has been shown to increase serum bicarbonate in adult patients. We conducted a prospective single-center study of pediatric dialysis patients comparing serum bicarbonate before and 3 months after a switch from sevelamer HCl to sevelamer carbonate. Inclusion criteria were a minimum of 3 months of dialysis therapy and either a serum bicarbonate <20 mmol/L or the need for sodium bicarbonate supplementation. Ten hemodialysis and 14 peritoneal dialysis patients, aged 16± 3 years, were enrolled. Whereas serum calcium and phosphorus remained unchanged, serum bicarbonate increased from 20 (17.2-22.0) to 24.5 (20.75-26) mmol/L (p<0.001) after 3 months of sevelamer carbonate therapy. Sodium bicarbonate supplementation was stopped in all patients (n=10), reducing the mean daily sodium intake by an average of 2.3 g per patient. These results demonstrate that sevelamer carbonate is an effective phosphate binder that improves acid-base status in pediatric dialysis patients.

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The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis

Abstract: This cross-sectional study suggests that salt restriction and reduced prescription of antihypertensive drugs may limit LV hypertrophy, better preserve LV functions and reduce intradialytic hypotension in HD patients.

Cited by 165 publications

References 26 publications

Assessment and Management of Hypertension in Patients on Dialysis

Assessment and Management of Hypertension in Patients on Dialysis

Effect of Tenapanor on Interdialytic Weight Gain in Patients on Hemodialysis

Sevelamer carbonate increases serum bicarbonate in pediatric dialysis patients

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