Effect of gradually lowering dialysate sodium concentration on the interdialytic weight gain, blood pressure, and extracellular water in anuric hemodialysis patients. (February 2014)

• Record Type: Journal Article
• Authors: Kim, Do Young; Kim, Beom; Moon, Kyoung Hyoub; Lee, Sangyoon; Lee, Dong-Young
• Is Part Of: Renal failure. Volume 36:Number 1(2014)
• Page Start: 23
• Page End: 27
• Publication Date: 2014-02
• Subjects: Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.3109/0886022X.2013.830360
• Languages: English
• ISSNs: 0886-022X

Abstract

<abstract> <title>Abstract</title> <p> <italic>Background:</italic> The majority of hemodialysis (HD) patients are overhydrated and have high interdialytic weight gain (IDWG) which induces increased blood pressure (BP). The positive sodium balance resulting from a high sodium diet, a high dialysate sodium concentration (DNa), or a combination of both is major causes of this disease. We evaluated the effects of lowering DNa on IDWG, BP, and volume status in anuric HD patients with dietary sodium restriction. <italic>Methods:</italic> Thirty-two patients were enrolled in this study and the period was divided by phase 1 and 2 according to DNa which decreased from 140 to 135 mEq/L at a rate of 1 mEq/L per month; phase 1, 140 mEq/L; phase 2, 135 mEq/L. We compared the IDWG, BP, volume status measured by multifrequency bioimpedance spectroscopy, and adverse events such as intradialytic hypotension, cramps, and headache of both phases. <italic>Results:</italic> The IDWG was significantly reduced by 0.39 ± 0.38 kg (<italic>p</italic> = 0.000). Pre-dialysis BP showed significant reduction (systolic pressure 146 ± 18 vs. 138 ± 22 mmHg; <italic>p</italic> = 0.012, diastolic pressure 80 ± 10 vs. 75 ± 11 mmHg; <italic>p</italic> = 0.008). Pre-dialysis extracellular water (ECW) was reduced significantly by 0.13 ± 2.22 L (<italic>p</italic> = 0.02). There was no significant increase in adverse events (all <italic>p</italic> > 0.05). <italic>Conclusions:</italic> This study showed that gradually lowering DNa could bring a significant reduction in pre-dialysis IDWG, BP, and ECW without increased adverse events. Large and crossover designed study will be needed to demonstrate the clear causal relationship.</p> </abstract>