The importance of dialysate sodium concentration in determining interdialytic weight gains in chronic hemodialysis patients: the PanThames Renal Audit.
OBJECTIVE
There is controversy as to the optimum dialysate sodium to be used for hemodialysis patients, with reports of hypertension and increased interdialytic weight gains with high sodium dialysates and intradialytic hypotension and cramps with low sodium dialysates.


METHODS
We analyzed the effect of different dialysate sodium concentrations during a one-week period in an audit of 2187 established patients regularly receiving dialysis three times a week. Patients were given general dietary advice to restrict dietary sodium intake, but no systematic assessment of dietary sodium intake was undertaken.


RESULTS
The prescription of a dialysate sodium concentration of 140 mmol/L and >140 mmol/L, was associated with greater interdialytic weight gains, 3.5% and 4.1% respectively, compared to 2.8% and 2.7% for those using dialysate sodium concentrations of 137 and 136 mmol/L, respectively (p0<.05). The mean pulse pressure was greater patients dialyzing using a sodium of 140 mmol/L, compared to 136 mmol/L, 70 (13) vs 63 (15) mmHg (p<0.011). In addition, 13.5% of patients using the highest sodium dialysate suffered symptomatic intradialytic hypotension requiring intravenous fluid resuscitation, compared to 2.7% who used the lowest sodium concentrate (p<0.05).


CONCLUSIONS
This analysis would support the use of lower dialysate sodium concentrations to aid in reducing interdialytic weight gains and subsequent intradialytic hypotension.
Davenport
A
A
UCL Center for Nephrology, Royal Free and University College Medical School, London - United Kingdom. Andrew.davenport@royalfree.nhs.uk
Cox
C
C
Thuraisingham
R
R
D000368:Aged; D005260:Female; D015312:Hemodialysis Solutions / Q000009:adverse effects* / Q000737:chemistry*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012964:Sodium / Q000009:adverse effects* / Q000032:analysis; D015430:Weight Gain
D015312:Hemodialysis Solutions; D012964:Sodium