Two Variable Sodium Profiles and Adverse Effects During Hemodialysis: A Randomized Crossover Study

Abstract

Intradialytic symptomatic hypotension and muscle cramps are frequent and disturbing adverse effects involving hemodialysis patients. The use of sodium profiling has been a proposed approach to preclude such events. The aim of the study was to compare the frequency of intradialytic adverse effects and changes in anthropometric and physiological variables without profiling and with two distinct sodium profiles. A prospective study randomized 22 stable hemodialysis patients to receive either a step (11 patients) or a linear (11 patients) dialysate sodium profile for 12 consecutive sessions, following a 12-session steady sodium control period. After a wash-out period of 12 sessions, the groups were crossed over for another 12-session period. Frequency of adverse effects, interdialytic weight gain, pre- and post-dialysis blood pressure were computed. The frequency of intradialytic adverse effects was significantly different between the control and either the step or linear periods (48.5%, 33.7%, and 36.0%, respectively; P < 0.001). No significant differences in interdialytic weight gain or pre-dialysis blood pressure were detected between treatment periods. The mean post-dialysis systolic blood pressure was lower in the linear period (128 +/- 21; 127 +/- 20; 123 +/- 22 mm Hg, for the control, step and linear periods, respectively; P = 0.014). Seven patients benefited from sodium profiling, yet two became more symptomatic. Overall, both sodium profiles were associated with fewer intradialytic adverse effects. Intradialytic symptomatic hypotension occurred less often with the step profile, while a tendency to fewer cramps was associated with the linear profile. However, sodium profiling may not benefit every dialysis patient and should be individually evaluated.

Evaluation of Physical Symptoms in Patients on Peritoneal Dialysis

“…Muscle cramps is a well known distressing adverse effect that may arise during a hemodialysis session, much related to the volume of ultrafiltration needed, that can reach an occurrence of 10−20% [18–20]. Surprisingly our prevalence of muscle cramps was far higher than in hemodialysis patients.…”

Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit

“…Intradialytic hypotension mitigating interventions for end‐stage renal disease patients include cool dialysate, albumin administration, sequential ultrafiltration (UF)‐HD and sodium modelling . Existing data suggest that sodium modelling mitigates IDH in the setting of routine ambulatory dialysis for end‐stage renal disease . Specifically, sodium modelling has been shown to decrease the number of hypotensive episodes during dialysis, decrease the number of nursing interventions required for IDH and decrease the number of symptoms attributed to hypotension .…”

“…Existing data suggest that sodium modelling mitigates IDH in the setting of routine ambulatory dialysis for end‐stage renal disease . Specifically, sodium modelling has been shown to decrease the number of hypotensive episodes during dialysis, decrease the number of nursing interventions required for IDH and decrease the number of symptoms attributed to hypotension . Compared with non‐modelled dialysis protocols, sodium modelling has been associated with higher mean arterial pressures and higher post‐HD blood pressure .…”

A meta‐analysis of sodium profiling techniques and the impact on intradialytic hypotension

“…Afferent and efferent dialysate sodium levels were included in only two studies . Sodium levels were measured using ion selective electrodes, however three studies did not state their method of sodium analysis . Only six studies analyzed predialysis sodium levels …”