title: Effects of mildly increasing dialysis sodium removal on renin and sympathetic system in hemodialysis patients.
abstract: BACKGROUND
  It has been argued that the benefits of reducing sodium loading may be offset by increased activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system. This study aimed to investigate the long-term effects of an increase in dialysis sodium removal on circulating RAAS and sympathetic system in hypertensive hemodialysis (HD) patients with "normal" post-HD volume status.
  
  
  METHODS
  Thirty hypertensive HD patients were enrolled in this pilot trial. After one month period of dialysis with standard dialysate sodium of 138 mmol/L, the patients were followed up for a four months period with dialysate sodium set at 136 mmol/L, without changes in instructions regarding dietary sodium control. During the period of study, the dry weight was adjusted monthly under the guidance of bioimpedance spectroscopy to maintain post-HD volume status in a steady state; 44-hour ambulatory blood pressure, plasma renin, angiotensin II (Ang II), aldosterone, and norepinephrine (NE) were measured.
  
  
  RESULTS
  After four months of HD with low dialysate sodium of 136 mmol/L, 44-hour systolic and diastolic blood pressures (BPs) were significantly lower (-10 and -6 mmHg), in the absence of changes in antihypertensive medications. No significant changes were observed in plasma renin, Ang II, aldosterone, and NE concentrations. The post-HD volume parameters were kept constant.
  
  
  CONCLUSIONS
  Mildly increasing dialysis sodium removal over 4 months can significantly improve BP control and does not activate circulating RAAS and sympathetic nervous system in hypertensive HD patients.
authors.affiliation: Faculty of Kidney Diseases, Capital Medical University, Beijing 100050, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Sun
authors.affiliation: Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Lijie
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China. Email: liuwh0211@126.com.
authors.forename: Yilun
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Wenhu
authors.initials: W
authors.lastname: Liu
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012964:Sodium / Q000494:pharmacology*; D013564:Sympathetic Nervous System / Q000187:drug effects*
chemical_list: D012964:Sodium