Increasing Dialysis Sodium Removal on Arterial Stiffness and Left Ventricular Hypertrophy in Hemodialysis Patients.
OBJECTIVE
The aim of the present study was to examine the effects of a mild increase in dialysis sodium removal on cardiovascular system in hypertensive hemodialysis (HD) patients.


METHODS
Sixty four HD patients with pre-HD plasma sodium level higher than 138mmol/l, were randomly assigned into 2 groups. The dialysate sodium was reduced from 138mmol/l to 136mmol/l in the intervention group, while remained at 138mmol/l in the control group. During the study course, home systolic blood pressure (BP) target of 140mmHg was used in all patients, and bioimpedance measurements to guide ultrafiltration were performed monthly. 44-hour ambulatory BP, aortic pulse wave velocity (PWV), left ventricular mass index (LVMI), pre-HD plasma sodium concentration, interdialytic weight gain, and dietary sodium intake, were measured.


RESULTS
Better BP control was achieved by 2 groups, with no significant differences. However, less annual averages of antihypertensives were used in the intervention group. The PWV values significantly decreased from 11.8±2.4 to 10.9±2.6m/s in the intervention group (P<0.001), and from 11.6±2.5 to 11.1±2.2m/s in the control group (P=0.012). LVMI regressed from 151±19 to 139±16 g/m2 (P<0.001) in the intervention group only. In addition, values for interdialytic weight gain and pre-HD plasma sodium decreased in the intervention group only. There were no significant differences in annual averages of dietary sodium intake and the frequency of adverse events between the 2 groups.


CONCLUSIONS
Increasing dialysis sodium removal was associated with improvements in arterial stiffness, left ventricular hypertrophy, and better BP control in hypertensive HD patients.
Department of Nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
Jing
J
Liu
Department of Nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
Fang
F
Sun
Department of Nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
Li-Jie
LJ
Ma
Department of Nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
Yang
Y
Shen
Department of Emergency Medicine, Chao-Yang Hospital, Capital Medical University, Beijing, China.
Xue
X
Mei
Department of Nephrology, Tian-Tan Hospital, Capital Medical University, Beijing, China. Electronic address: zhouyilun2008@sina.cn.
Yi-Lun
YL
Zhou
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D012982:Sodium, Dietary / Q000097:blood*; D059289:Vascular Stiffness; D015430:Weight Gain
D000959:Antihypertensive Agents; D012982:Sodium, Dietary