title: Effect of gradually lowering dialysate sodium concentration on the interdialytic weight gain, blood pressure, and extracellular water in anuric hemodialysis patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  The IDWG was significantly reduced by 0.39 ± 0.38 kg (p = 0.000). Pre-dialysis BP showed significant reduction (systolic pressure 146 ± 18 vs. 138 ± 22 mmHg; p = 0.012, diastolic pressure 80 ± 10 vs. 75 ± 11 mmHg; p = 0.008). Pre-dialysis extracellular water (ECW) was reduced significantly by 0.13 ± 2.22 L (p = 0.02). There was no significant increase in adverse events (all p > 0.05).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Seoul Veterans Hospital , Seoul , Korea and.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Beom
authors.initials: B
authors.lastname: Kim
authors.forename: Kyoung Hyoub
authors.initials: KH
authors.lastname: Moon
authors.forename: Sangyoon
authors.initials: S
authors.lastname: Lee
authors.forename: Dong-Young
authors.initials: DY
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001002:Anuria / Q000503:physiopathology / Q000628:therapy; D001794:Blood Pressure / Q000187:drug effects; D015314:Dialysis Solutions; D045604:Extracellular Fluid / Q000187:drug effects; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis; D012964:Sodium / Q000008:administration & dosage; D015430:Weight Gain / Q000187:drug effects
chemical_list: D015314:Dialysis Solutions; D012964:Sodium