Time-averaged concentration of dialysate sodium relates with sodium load and interdialytic weight gain during sodium-profiling hemodialysis

Song, Jang-Ho; Lee, Seoung Woo; Suh, Chang-Kook; Kim, Moon‐Jae

doi:10.1053/ajkd.2002.34507

Cited by 105 publications

(80 citation statements)

References 24 publications

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“…In addition, BP effects were amplified according to the gradient between dialysate and plasma sodium. The authors showed that the difference between dialysate TAC sodium and pre-HD plasma sodium had a modest but significant correlation with interdialytic ambulatory diastolic BP (r ϭ 0.36, P Ͻ 0.05) (33). These findings were consistent with those of other investigators who evaluated the effect of this dialysate-to-plasma sodium gradient on dialysis sodium losses (34) and IDWG (5,31,35,36).…”

Section: Sodium Balance and Bp In Hemodialysissupporting

confidence: 78%

“…Higher dialysate TAC sodium resulted in significant, stepwise increases in thirst scores, IDWG (r ϭ 0.823, P Ͻ 0.001) and ambulatory BP during the interdialytic period (136/82 mmHg TAC sodium 138 mEq/L, 139/81 mmHg TAC sodium 140 mEq/L, 147/84 mmHg TAC sodium 147 mEq/L, P Ͻ 0.01) (33). In addition, BP effects were amplified according to the gradient between dialysate and plasma sodium.…”

Section: Sodium Balance and Bp In Hemodialysismentioning

confidence: 98%

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Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Santos

Peixoto

2008

Clinical Journal of the American Society of Nephrology

134

100

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Hypertension and chronic volume overload are complications often seen in hemodialysis patients. Current hemodialysis practices adopt a standard dialysate sodium prescription that is typically higher than the plasma sodium concentration of most patients. As a general rule, hemodialysis patients have stable predialysis plasma sodium concentrations, and each patient has a fixed "osmolar set point." Hypertonic dialysate sodium prescriptions, including sodium modeling, predispose to positive sodium balance and lead to higher blood pressure and increased interdialytic weight gain. Conversely, lowering or individualizing dialysate sodium reduces thirst, interdialytic weight gain, and blood pressure in non-hypotension prone dialysis patients. Optimization of the dialysate sodium prescription is an important step in achieving sodium balance and improving blood pressure control in hypertensive hemodialysis patients.

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Section: Sodium Balance and Bp In Hemodialysissupporting

confidence: 78%

Section: Sodium Balance and Bp In Hemodialysismentioning

confidence: 98%

Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Santos

Peixoto

2008

Clinical Journal of the American Society of Nephrology

134

100

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“…[18] A crossover trial comparing the effects of conventional dialysis with different time-averaged sodium dialysate concentration (TAC Na ) did not find significant correlations between TAC Na and blood pressure, despite the strong effects on plasma sodium and interdialytic weight gain. [19] The activation of the sympathetic nervous system, well recognized in chronic renal disease, is thought to be an important mechanism of hypertension in hemodialysis patients. Studies using intraneural direct recordings of muscle sympathetic nerve activity (MSNA) have shown an increased sympathetic discharge in patients with renal insufficiency and on chronic hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

et al. 2008

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Background. Autonomic nervous system dysfunction and dialysate sodium (Na) concentration are believed to play a role in the pathogenesis of hemodialysis-related hypertension. The present study was undertaken to determine whether increases in blood pressure in hemodialysis patients are associated with changes in heart rate variability (HRV), a measure of the autonomic nervous system function, and long-term exposure to increased dialysate Na concentration. Methods. Baseline clinical, biochemical data and HRV of patients undergoing increased Na profiling dialysis (High-Na, n = 9) and on conventional treatment (Control, n = 11) were compared with those obtained after one year of study. Results. After one year, the mean predialysis systolic blood pressure (SBP) increased in seven patients of the High-Na and in five of the Control group, and decreased or remained unchanged in the remaining subjects. Initial HRV was significantly higher in patients with increased SBP, and it increased further in these patients after one year. At the end of the study, post-dialysis plasma Na, osmolality, and weight gains were significantly higher in the High-Na group. No significant correlation, however, was found between individual changes in intradialytic sodium elimination and the alterations in blood pressure. Conclusion. These data suggest that the dialysate sodium concentration, a most important determinant of interdialytic weight gain and fluid balance, is only partly correlated with longterm changes in blood pressure. An increased blood pressure over time may develop in a subset of hemodialysis patients with higher HRV, suggestive of increased sympathetic activity.

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“…94 Interdialytic 24-hour ambulatory BP increased when the time-averaged concentration of sodium was extremely elevated at 147 mEq/dl. 95 Therefore, one sodium prescription may not fit all patients.…”

Section: Dietary Sodium Restrictionmentioning

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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Time-averaged concentration of dialysate sodium relates with sodium load and interdialytic weight gain during sodium-profiling hemodialysis

Cited by 105 publications

References 24 publications

Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

Assessment and Management of Hypertension in Patients on Dialysis

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