title: Efficacy of stepwise sodium profile versus individualized dialysate sodium in blood pressure control among hemodialysis patients.
abstract: BACKGROUND
  Hypertension is very common in patients with end-stage renal disease and accelerates cardiovascular morbidity and mortality. The most important factor in achieving normal blood pressure in these patients is reaching dry weight. Sodium and extracellular fluid balance play a vital role in this regard. Considering the lack of consensus about the efficacy of stepwise sodium profile and individualized dialysate sodium, this study aimed to determine the superior method for blood pressure control in hemodialysis patients.
  
  
  METHODS
  In a quasi-experimental study, patients satisfying the inclusion criteria were enrolled through convenience sampling. The patients were randomly assigned to two groups of stepwise sodium profile and individualized dialysate sodium. Information record form was used for data collection. Data were analyzed with paired and independent t-test and descriptive statistics using SPSS for Windows 20.0.
  
  
  RESULTS
  Patients in the two groups were similar in qualitative and quantitative background variables. While systolic blood pressure significantly decreased following hemodialysis with individualized dialysate sodium (P < 0.001), there was no significant difference between pre- and post-dialysis systolic blood pressure values using stepwise sodium profile (P = 0.060). Individualized dialysate sodium caused greater change in the mean systolic blood pressure than stepwise sodium profile did (P = 0.040). Pre- and post-dialysis diastolic blood pressure values showed significant differences in both groups (P < 0.001 using individualized dialysate sodium and P = 0.009 using stepwise sodium profile). However, the mean changes in diastolic blood pressure of the two groups were not significantly different (P = 0.295).
  
  
  CONCLUSIONS
  We found no significant difference in interdialytic weight gain and blood pressure control by the two methods. The change in systolic blood pressure was lower in the stepwise profile method than in the individualized dialysate sodium method, and this method did not cause interdialytic hypertension. So, by adjusting the dialysis solution with regard to plasma sodium levels, lead to more blood pressure control. Meanwhile, the two groups were not significantly different in the mean changes of diastolic blood pressure.
authors.affiliation: Department of Critical Care, Isfahan Kidney Disease Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Shahgholian
authors.affiliation: PhD Candidate in Nursing, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Maryam Sadat
authors.initials: MS
authors.lastname: Hashemi
authors.affiliation: Department of Nephrology, Isfahan Kidney Disease Research Center, School of Medicine, Isfahan, Iran.
authors.forename: Shahrzade
authors.initials: S
authors.lastname: Shahidi
keywords: Dialysate; hemodialysis; hypertension; interdialytic weight gain