title: Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension.
abstract: BACKGROUND
  Symptomatic hypotension is the most frequent complication in patients receiving haemodialysis (HD). Previous studies have reported that the use of modulating dialysate sodium concentration or ultrafiltration (UF) rates, or the combination use of sodium profile and UF profile may better preserve blood volume and reduce the incidence of hypotensive episodes. The aim of this study was to evaluate the effects of sodium balance-neutral sodium profile and UF profile and their combination on preservation of blood volume, cardiac function and occurrence of hypotensive episodes.
  
  
  METHODS
  Using Fresenius MC 4008S, eight stable HD patients underwent four treatments: (1) control, constant dialysate sodium concentration of 138 mmol/l with constant UF; (2) sodium profile, a linearly decreasing dialysate sodium concentration (148-131 mmol/l) with constant UF; (3) UF profile, a linearly decreasing UF rate with dialysate sodium concentration of 138 mmol/l; (4) sodium+UF profile, combination of sodium and UF profile. Each treatment was applied in 10 dialysis sessions. Relative blood volume (RBV), mean blood pressure (MBP), heart rate (HR), interior vena cava diameter (IVCD), stroke volume (SV), cardiac output (CO), plasma sodium concentration and the frequency of symptomatic hypotension were monitored.
  
  
  RESULTS
  There were no significant differences in the IVCD, MBP, SV, CO and body weight before dialysis between the three profiles and the control. The total plasma protein, haemoglobin, and intradialytic sodium mass removal showed similar results. Compared with the control, better preservation of RBV and MBP at 4 and 5 h and a higher stability in SV variation, but larger UF volume were achieved during sodium+UF profile (P<0.05, respectively), the incidence of intradialytic hypotension was significantly reduced (P<0.05).
  
  
  CONCLUSIONS
  With the similar intradialytic sodium removal, during sodium balance-neutral linearly decreasing sodium profile combined with linearly decreasing UF profile, greater intradialytic stability of the blood volume, blood pressure and cardiac function could be obtained, and hypotensive episodes were significantly reduced.
authors.affiliation: Division of Nephrology, FuXing Hospital, Capital University of Medical Science, #20 Fuxingmenwai Street, Beijing 100038, China.
authors.forename: Yi Lun
authors.initials: YL
authors.lastname: Zhou
authors.forename: Hui Lan
authors.initials: HL
authors.lastname: Liu
authors.forename: Xiao Feng
authors.initials: XF
authors.lastname: Duan
authors.forename: Ying
authors.initials: Y
authors.lastname: Yao
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.forename: Qun
authors.initials: Q
authors.lastname: Liu
mesh_terms: D001794:Blood Pressure; D001811:Blood Volume Determination; D005260:Female; D006334:Heart Function Tests; D006339:Heart Rate; D017583:Hemodiafiltration; D006801:Humans; D007022:Hypotension / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012964:Sodium / Q000097:blood / Q000502:physiology*
chemical_list: D012964:Sodium