NDT Advance Access first published online on May 17, 2007
This version published online on June 25, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm220
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Associations of a facility level decrease in dialysate sodium concentration with blood pressure and interdialytic weight gain
1Department of Renal Medicine, Whangarei Hospital, Whangarei 2Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand
Correspondence and offprint requests to: Dr M. R. Marshall, Department of Renal Medicine, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand. Email: renal{at}woosh.co.nz
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Abstract |
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Background. Dialysate [Na+] is often overlooked as a contributor to hypertension in patients on haemodialysis (HD). We report observational experience with a facility level decrease in dialysate [Na+] from 141 mmol/l to 138 mmol/l, in the absence of concurrent change with respect to dietary sodium regulation.
Methods. The sample comprised all patients (n = 52) dialysing at a single HD facility over an 8-month period flanking the change in dialysate [Na+]. Outcomes included repeated observations of blood pressure (BP), interdialytic weight gain (IDWG), pre-dialysis plasma [Na+] and adverse events. Predictors other than dialysate [Na+] included patient demographics, clinical characteristics and number of antihypertensive medications. The study used a longitudinal unbalanced panel design, and hierarchical linear and Poisson mixed models.
Results. In multivariate analyses, the change in dialysate [Na+] was associated with a statistically significant small to medium-sized decrease in pre- and post-dialysis systolic and diastolic BP, pre-dialysis plasma [Na+], but not IDWG. Change was greatest in the patient tertile with the highest initial BP. There was no change in the frequency of adverse events. Modelling dialysate [Na+] exposure as the diffusion gradient from dialysate to blood water did not improve the strength of associations.
Conclusions. A facility level decrease in dialysate [Na+] from 141 mmol/l to 138 mmol/l appears to be safe and well tolerated, and a useful means of improving BP control. The lack of change in IDWG probably reflects lack of dietary salt restriction, and but does raise the issue of volume-independent effects of sodium exposure on BP.
Keywords: dialysate sodium; haemodialysis; hypertension; interdialytic weight gain
Received for publication: 2. 9.06
Accepted in revised form: 21. 3.07
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  S. F. F. Santos and A. J. Peixoto Revisiting the Dialysate Sodium Prescription as a Tool for Better Blood Pressure and Interdialytic Weight Gain Management in Hemodialysis Patients Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 522 - 530. [Abstract] [Full Text] [PDF]
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