title: Clinical Effects of Standard and Individualized Dialysate Sodium in Patients on Maintenance Hemodialysis.
abstract: BACKGROUND
  The degree to which the dialysate prescription and, in particular, the dialysate sodium concentration influences blood pressure and interdialytic weight gain (IDWG) via changes in sodium flux, plasma volume or the other parameters is not well understood. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium or sodium modeling.
  
  
  METHODS
  Ninety-two nondiabetic subjects (52 men and 40 women) performed 12 consecutive hemodialysis (HD) sessions (4 weeks) with dialysate sodium concentration set up on 138 mmol/L (standard sodium - first phase), followed by 24 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic and mean blood pressure, pulse, IDWG, thirst score - (Xerostomia Inventory (XI) and Dialysis Thirst Inventory (DTI)) and side effects (occurrence of hypotension and muscle cramps). After the first phase, the subjects were divided into 3 groups: normotensive (N=76), hypertensive (N= 11) and hypotensive (N=5) based on the average pre-HD systolic BP during the whole period of the first phase.
  
  
  RESULTS
  Sodium individualization resulted in significantly lower blood pressure (133.61 ± 11.88 versus 153.60 ± 14.26 mmHg; p=0.000) and IDWG (2.21 ± 0.93 versus 1.87 ± 0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21 ± 0.72 versus 2.06 ± 0.65, p=0,004). Sodium profiling in hypotensive patients significantly increased IDWG (2.45 vs. 2.74, p= 0,006), and had no impact on blood pressure. Thirst score was significantly lower in normotensive patients with individualized-sodium HD and showed no change in the other two groups. During the second phase, hypotension occurred in only 1 case and muscle cramps in 10 normotensive patients.
  
  
  CONCLUSIONS
  Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients.
authors.affiliation: Specialized Hospital for Nephrology and Dialysis "Diamed", Skopje, Republic of Macedonia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Eftimovska-Otovic
authors.affiliation: University Clinic for Nephrology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
authors.forename: Olivera
authors.initials: O
authors.lastname: Stojceva-Taneva
authors.affiliation: Specialized Hospital for Nephrology and Dialysis "Diamed", Skopje, Republic of Macedonia.
authors.forename: Risto
authors.initials: R
authors.lastname: Grozdanovski
authors.affiliation: General City Hospital "8th September", Skopje, Republic of Macedonia.
authors.forename: Saso
authors.initials: S
authors.lastname: Stojcev
keywords: blood pressure; dialysate sodium; hemodialysis; thirst