Time-averaged concentration of dialysate sodium relates with sodium load and interdialytic weight gain during sodium-profiling hemodialysis.
BACKGROUND
Factors determining sodium level during sodium-profiling hemodialysis rarely have been studied. We hypothesized that the time-averaged concentration of dialysate sodium (TAC(Na)) is related to intradialytic sodium load and interdialytic complications.


METHODS
Eleven patients underwent 6-week periods of (1) conventional hemodialysis with a dialysate sodium concentration of 138 mmol/L (TAC(138)) and (2) sodium-profiling hemodialysis with a dialysate sodium concentration of 150 to 138 mmol/L (TAC(Na), 140 mmol/L [TAC(140)]) and (3) 155 to 130 mmol/L (TAC(Na), 147 mmol/L [TAC(147)]). Serum sodium level, weight gain, 24-hour blood pressure, and intradialytic and interdialytic discomfort were compared.


RESULTS
Serum sodium levels increased during the TAC(140) and TAC(147) periods (P < 0.05 compared with predialysis serum sodium). Intradialytic change in sodium level correlated positively with TAC(Na) (r = 0.945; P < 0.001). Regression analysis indicates that positive sodium load occurred with TAC(Na) more than 137.8 mmol/L. Interdialytic weight gain increased in proportion to TAC(Na) (P < 0.05 compared with each other period), with a positive correlation (r = 0.823; P < 0.001). TAC(Na) causing interdialytic weight gain less than 3 kg was estimated to be less than 143.5 mmol/L. Intradialytic hypotension decreased, but interdialytic discomforts increased during the TAC(147) period (P < 0.05 compared with TAC(138) and TAC(140)). Mean 24-hour blood pressures and pressure loads increased during the TAC(147) period (P < 0.05 compared with TAC(138) and TAC(140)). Mean diastolic blood pressure correlated positively with TAC(Na) (r = 0.354; P < 0.05).


CONCLUSIONS
TAC(Na) is a factor determining sodium load and interdialytic complications during sodium-profiling hemodialysis. Defining the optimal TAC(Na) for individual centers based on their protocols will be helpful to avoid sodium load and excessive weight gain.
Song
Joon Ho
JH
Department of Internal Medicine, Inha University College of Medicine, Inchon City, Korea.
Lee
Seoung Woo
SW
Suh
Chang-Kook
CK
Kim
Moon-Jae
MJ
D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000378:metabolism*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012964:Sodium / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000378:metabolism*; D013997:Time Factors; D015430:Weight Gain / Q000187:drug effects / Q000502:physiology*
D015314:Dialysis Solutions; D012964:Sodium