Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients.
BACKGROUND
Predialysis plasma sodium (Na(+)) concentration is relatively constant in hemodialysis (HD) patients, and a higher dialysate Na(+) concentration can promote an increase in the interdialytic fluid ingestion to achieve an individual's osmolar set point, and individualization of dialysate Na(+) concentration may improve interdialytic weight gain (IDWG), blood pressure (BP), and HD-related symptoms.


METHODS
Twenty-seven nondiabetic, non-hypotension prone HD patients were enrolled in a single-blind crossover study. Subjects underwent nine consecutive HD sessions with the dialysate Na(+) concentration set to 138 mEq/L (standard Na(+) HD), followed by nine sessions wherein the dialysate Na(+) was set to match the patients average pre-HD plasma Na(+) measured three times during the standard Na(+) phase multiplied by 0.95 (individualized dialysate Na(+) HD). Dry weight, dialysis prescription, and medications were not modified during the six weeks of the study.


RESULTS
Pre-HD Na(+) was similar in both periods of the study (standard Na(+) HD, 134.0 +/- 1.4 mEq/L; individualized Na(+) HD, 134.0 +/- 1.5 mEq/L; P= 0.735). There was a significant decrease in interdialytic weight gain (2.91 +/- 0.87 kg vs. 2.29 +/- 0.65 kg; P< 0.001), interdialytic thirst scores, and episodes of intradialytic hypotension in the individualized Na(+) period compared with the standard phase. Pre-HD BP was lower in individualized Na(+) HD in patients with uncontrolled BP at baseline (N= 15), but not in those with controlled BP at baseline (N= 12) (DeltaBP -15.6/-6.5 mm Hg in uncontrolled vs. DeltaBP +6.4/+4.5 mm Hg in controlled, P= <0.001 for systolic BP and P= <0.001 for diastolic BP).


CONCLUSIONS
An individualized Na(+) dialysate based on predialysis plasma Na(+) levels decreases thirst, IDWG, HD-related symptoms, and pre-HD BP (in patients with uncontrolled BP at baseline).
de Paula
Flavio M
FM
Division of Nephrology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Peixoto
Aldo J
AJ
Pinto
Luciano V
LV
Dorigo
David
D
Patricio
Pedro J M
PJ
Santos
Sergio F F
SF
D000328:Adult; D001794:Blood Pressure; D018592:Cross-Over Studies; D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012964:Sodium / Q000008:administration & dosage* / Q000097:blood
D015312:Hemodialysis Solutions; D012964:Sodium