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NDT Advance Access published online on August 31, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh427
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received March 17, 2004
Accepted June 24, 2004

Brief Report

Low sodium haemodialysis reduces interdialytic fluid consumption but paradoxically increases post-dialysis thirst

Alister Oliver 1, Mark Wright 2*, Andrew Matson 1, Graham Woodrow 2, Neil King 3, Louise Dye 3

1 Leeds University School of Medicine, Leeds University, Leeds, UK
2 Renal Unit, Leeds General Infirmary, Leeds University, Leeds, UK
3 Department of Psychology, Leeds University, Leeds, UK

* To whom correspondence should be addressed. E-mail: mark.wright{at}leedsth.nhs.uk.



  Abstract

Background. Interdialytic weight gain (IDWG) can be reduced by lowering the dialysate sodium concentration ([Na]) in haemodialysis patients. It has been assumed that this is because thirst is reduced, although this has been difficult to prove. We compared thirst patterns in stable haemodialysis patients with high and low IDWG using a novel technique and compared the effect of low sodium dialysis (LSD) with normal sodium dialysis (NSD).

Methods. Eight patients with initial high IDWG and seven with low IDWG completed hourly visual analogue ratings of thirst using a modified palmtop computer during the dialysis day and the interdialytic day. The dialysate [Na] was progressively reduced by up to 5 mmol/l over five treatments. Dialysis continued at the lowest attained [Na] for 2 weeks and the measurements were repeated. The dialysate [Na] then returned to baseline and the process was repeated.

Results. Baseline interdialytic day mean thirst was higher than the dialysis day mean for the high IDWG group (49.9±14.0 vs 36.2±16.6) and higher than the low weight gain group (49.9±14.0 vs 34.1±14.6). This trend persisted on LSD, but there was a pronounced increase in post-dialysis thirst scores for both groups (high IDWG: 46±13 vs 30±21; low IDWG: 48±24 vs 33±18). The high IDWG group demonstrated lower IDWG during LSD than NSD (2.23±0.98 vs 2.86±0.38 kg; P<0.05).

Conclusions. Our results indicate that patients with high IDWG experience more intense feelings of thirst on the interdialytic day. LSD reduces their IDWG, but paradoxically increases thirst in the immediate post-dialysis period.

Keywords: thirst; weight gain; low sodium haemodialysis.
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