The effect of low-sodium dialysate on ambulatory blood pressure measurement parameters in patients undergoing hemodialysis

Akdağ, Serkan; Akyol, Aytaç; Çakmak, Hüseyin Altuğ; Tosu, Aydın Rodi; Aşker, Müntecep; Yaman, Mehmet; Babat, Naci; Soyoral, Yasemin Usul; Çeğin, Muhammed Bilal; Gür, Ali Kemal; Gümrükçüoğlu, Hasan Ali

doi:10.2147/tcrm.s94889

Cited by 11 publications

(4 citation statements)

References 40 publications

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“…We previously found that dialysate sodium profiling can reduce postdialysis BP in hypertensive patients on maintenance hemodialysis [12]; in the current study, we further identified that dialysate sodium profiling, compared to regular dialysate sodium status, effectively decreases interdialytic ABP and use of antihypertensive medication. Another study similarly showed that low-sodium dialysate can reduce morning and night ABP over a period of six months [13]. Inrig et al [14] conducted a randomized study, comparing hemodialysis patients receiving low-and high-sodium dialysate for three weeks, and found that low-sodium dialysate leads to a mean 9-mmHg decrease in systolic BP, consistent with our findings.…”

Section: Discussionsupporting

confidence: 89%

Impact of sodium profiling on ambulatory blood pressure in patients on maintenance hemodialysis

Lihui

Zhang

et al. 2017

Srp Arh Celok Lek

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Introduction/Objective Most patients with end-stage renal disease (ESRD) have hypertension. However, dialysis-related strategies to optimize blood pressure in these patients remain controversial. The current study aims to investigate the influence of dialysate sodium profiling on ambulatory blood pressure (ABP) in patients on maintenance hemodialysis, when there are no adequate dialytic and economic resources or high patient compliance. Methods This prospective, single-center study enrolled 60 hypertensive ESRD patients. Subjects received maintenance dialysis with regular dialysate sodium concentration (140 mmol/L) during the initial three months after the enrollment, and were randomly assigned to continue regular sodium dialysate (group A) or switch to sodium profiling (group B) for duration of three months. ABP, heart rate (HR), pre-/postdialysis serum sodium levels, antihypertensive treatment dosages, and interdialytic weight gain (IDWG) etc. were recorded after treatment assignment. Results Thirty patients each were enrolled in groups A and B. The characteristics at baseline were not significantly different between the two groups. Compared to patients in group A three months later, patients in group B had lower systolic ABP (p = 0.00), HR (p = 0.04), IDWG (p = 0.04), and antihypertensive medication dosages (p = 0.04). Throughout the treatment duration, no significant inter-group differences were observed for pre-/post-dialysis serum sodium and intradialytic complications. Additionally, no significant correlations were found between systolic or diastolic ABP and other variables studied in this study. Conclusion In this study, we found that dialysate sodium profiling successfully ameliorated hypertension and reduced BP medications without altering natremic levels or increasing complications among patients on maintenance hemodialysis during the three months. Dialysate sodium profiling was relatively safe in this duration.

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Section: Discussionsupporting

confidence: 89%

Impact of sodium profiling on ambulatory blood pressure in patients on maintenance hemodialysis

Lihui

Zhang

et al. 2017

Srp Arh Celok Lek

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“…They noted reduced IDWG from 2.3±0.9 to 1.6±0.6 kg ( P <.001) in the interventional group as well as lower ambulatory blood pressure (24‐hour SBP 136±22 at baseline to 127±19 mm Hg after 6 months, P <.05; Daytime SBP 138±22 to 130±19, P <.05; Nighttime SBP 131±26 to 120±27, P <.05; Nighttime DBP 69±11 to 64±8, P <.05) and blood pressure medications (2.1±0.8 to 1.2±0.4, P <.001), with nonsignificant changes in the standard D‐Na group. Three patients withdrew from the low D‐Na arm because of cramps or lDH …”

Section: Intermediate Outcomes After Universal Reductions In Dialysatmentioning

confidence: 99%

Dialysate sodium and intradialytic hypotension

Hussein

Schiller

2017

Seminars in Dialysis

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Intradialytic hypotension (IDH) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain (IDWG), high ultrafiltration rates (UFR), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D-Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG, UFR, and hypertension. On the other hand, high dialysate sodium is associated with more hemodynamic benefits in an unstable patient. The resulting sodium loading may, however, induce a vicious cycle of higher IDWG, requiring more rapid ultrafiltration, eventually contributing to intradialytic symptoms and hypotension. In this article, we review the available literature on fixed and profiled dialysate sodium prescriptions, and we recommend a tailored approach that considers the patient's status to optimize dialysis delivery.

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“…IDWG at baseline and 12 months was in the intervention group 3.3 ± 0.7 kg and 2.8 ± 0.6 kg ( p < 0.05) and, in the control group, 3.1 ± 0.8 kg and 3.0 ± 1 kg ( p > 0.05). Akdag et al [ 38 ] randomized 46 patients, dialyzed with 140 dialysate sodium concentration, into a control group (24 patients) that maintained the dialysate 140 mmol sodium concentration and a treatment group in which the dialysate sodium concentration was reduced to 137 mmol/l. IDWG at baseline and 6 months was, in the intervention group, 2.2 ± 0.9 kg and 1.6 ± 0.5 kg ( p < 0.001) and, in the control group, 2.3 ± 0.8 kg and 2.1 ± 0.7 kg ( p > 0.05).…”

Section: Resultsmentioning

confidence: 99%

Interdialytic weight gain and low dialysate sodium concentration in patients on chronic hemodialysis: a systematic review and meta-analysis

Bossola,

Mariani,

Sacco

et al. 2024

Int Urol Nephrol

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Purpose The present systematic review and meta-analysis aimed at evaluating the effect of low dialysate sodium concentration on interdialytic weight gain (IDWG) in chronic hemodialysis patients. Methods Studies were eligible for inclusion if they were English language papers published in a peer-reviewed journal and met the following inclusion criteria: (1) studies in adult patients (over 18 years of age), (2) included patients on chronic hemodialysis since at least 6 months; (3) compared standard (138–140 mmol/l) or high (> 140 mmol/l) dialysate sodium concentration with low (< 138 mmol/l) dialysate sodium concentration; (4) Included one outcome of interest: interdialytic weight gain. Medline, PubMed, Web of Science, and the Cochrane Library were searched for the quality of reporting for each study was performed using the Quality Assessment Tool of Controlled Intervention Studies of the National Institutes of Health. The quality of reporting of each cross-over study was performed using the Revised Cochrane Risk of Bias (RoB) tool for cross-over trials as proposed by Ding et al. Results Nineteen studies (710 patients) were included in the analysis: 15 were cross-over and 4 parallel randomized controlled studies. In cross-over studies, pooled analysis revealed that dialysate sodium concentration reduced IDWG with a pooled MD of − 0.40 kg (95% CI − 0.50 to − 0.30; p < 0.001). The systematic review of four parallel, randomized, studies revealed that the use of a low dialysate sodium concentration was associated with a significant reduction of the IDWG in two studies, sustained and almost significant (p = 0.05) reduction in one study, and not significant reduction in one study. Conclusion Low dialysate sodium concentration reduces the IDWG in prevalent patients on chronic hemodialysis.

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The effect of low-sodium dialysate on ambulatory blood pressure measurement parameters in patients undergoing hemodialysis

Cited by 11 publications

References 40 publications

Impact of sodium profiling on ambulatory blood pressure in patients on maintenance hemodialysis

Impact of sodium profiling on ambulatory blood pressure in patients on maintenance hemodialysis

Dialysate sodium and intradialytic hypotension

Interdialytic weight gain and low dialysate sodium concentration in patients on chronic hemodialysis: a systematic review and meta-analysis

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