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Combined Clinical Consequences of an Individualized Dialysate Sodium Prescription and Dietary Sodium Restriction in Hemodialysis Patients

Limesh M.* , Limesh M.* , Atul Desai* , Renuka S.** , Prashanth Kedalaya***

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Urology, Nephrology and Andrology International 1(2):p 53-59, July - December 2016. | DOI: N/A

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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 lower than serum sodium. Material and Methods: Fifty patients (38 men and 12 women) underwent 20 consecutive hemodialysis (HD) sessions (8 weeks) with dialysate sodium concentration set up on 139 mmol/L (standard sodium – first phase), followed by 20 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic blood pressure, IDWG, thirst score – ( Dialysis Thirst Inventory (DTI)) and complications (occurrence of hypotension and muscle cramps). Results: Sodium individualization resulted in significantly lower blood pressure (BP =-11.6/-3.5 mm Hg, P < 0.001 for systolic BP and BP = -2/-6.46 mm hg [P =0.194] for diastolic BP) and IDWG (+, 2.8 ± 0.75 kg; individualized Na+ 2.2 ± 0.61 kg; P < 0.001). Thirst score was not significantly lower in patients with individualized-sodium than compared to standard Na group. There were no significant changes in terms of complications such as hypotension. Conclusion: Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients.

Keywords: Interdialytic weight gain (IDWG); Hemodialysis (HD); Dialysis Thirst Inventory (DTI)

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