NDT Advance Access originally published online on November 11, 2008
Nephrology Dialysis Transplantation 2009 24(3):956-962; doi:10.1093/ndt/gfn599
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The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis
1 Department of Cardiology, Ege University School of Medicine, Izmir 2 Department of Cardiology, Gazi Osmanpasa University School of Medicine, Tokat 3 Division of Nephrology, Ege University School of Medicine 4 Department of Cardiology, Izmir-Tepecik Training and Research Hospital, Izmir 5 FMC Clinics, Izmir, Turkey
Correspondence and offprint requests to: Meral Kayikcioglu, Gediz caddesi 11/2, Bornova Izmir 35040, Turkey. Tel: +90-532-4123489; Fax: +90-232-3903287; E-mail: meral.kayikcioglu{at}ege.edu.tr
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Abstract |
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Background. Most haemodialysis (HD) centres use anti-hypertensive drugs for the management of hypertension, whereas some centres apply dietary salt restriction strategy. In this retrospective cross-sectional study, we assessed the effectiveness and cardiac consequences of these two strategies.
Methods. We enrolled all patients from two dialysis centres, who had been on a standard HD programme at the same centre for at least 1 year. All patients underwent echocardiographic evaluation. Clinical data were obtained from patients’ charts. Centre A (n = 190) practiced ‘salt restriction’ strategy and Centre B (n = 204) practiced anti-hypertensive-based strategy. Salt restriction was defined as managing high blood pressure (BP) via lowering dry weight by strict salt restriction and insistent ultrafiltration without using anti-hypertensive drugs.
Results. There was no difference regarding age, gender, diabetes, history of cardiovascular disease and efficiency of dialysis between centres. Antihypertensive drugs were used in 7% of the patients in Centre A and 42% in Centre B (P < 0.01); interdialytic weight gain was significantly lower in Centre A (2.29 ± 0.83 kgversus 3.31 ± 1.12 kg, P < 0.001). Mean systolic and diastolic blood pressures were similar in the two centres. However, Centre A had lower left ventricular (LV) mass (indexed for height2.7: 59 ± 16 versus 74 ± 27 g/m2.7, P < 0.0001). The frequency of LV hypertrophy was lower in Centre A (74% versus 88%, P < 0.001). Diastolic and systolic functions were better preserved in Centre A. Intradialytic hypotension (hypotensive episodes/100 patient sessions) was more frequent in Centre B (11 versus 27, P <0.01).
Conclusions. This cross-sectional study suggests that salt restriction and reduced prescription of antihypertensive drugs may limit LV hypertrophy, better preserve LV functions and reduce intradialytic hypotension in HD patients.
Keywords: echocardiography; haemodialysis; hypertension; left ventricular hypertrophy; salt restriction
Received for publication: 31. 7.08
Accepted in revised form: 30. 9.08
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