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NDT Advance Access published online on January 14, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn668
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© The Author [2009].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status

Simon Davies1, Ola Carlsson2, Ole Simonsen3, Ann-Cathrine Johansson4, Daniele Venturoli3, Ingrid Ledebo2, Anders Wieslander2, Cian Chan1 and Bengt Rippe3

1 Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK 2 Gambro Research, Gambro Lundia AB 3 Department of Nephrology, Lund University, University Hospital of Lund, Lund 4 Department of Nephrology, Lund University, University Hospital of Malmö, Malmö, Sweden

Correspondence and offprint requests to: Simon Davies, Department of Nephrology, University Hospital of North Staffordshire, Princes Road, Hartshill, Stoke-on-Trent, ST4 7LN, UK. Tel: +44-1782-554164; Fax: +44-1782-620759; E-mail: SimonDavies1{at}compuserve.com



  Abstract

Background. Poor ultrafiltration is associated with worse outcomes in peritoneal dialysis (PD) patients. This might in part reflect problems associated with salt and water excess. Increasing the diffusive component of peritoneal sodium removal using low-sodium PD fluids might have beneficial effects on blood pressure (BP), thirst and fluid status that could translate into clinical benefits.

Methods. Using a multicentre, prospective, baseline controlled (1 month), non-randomized intervention (2 months) design, two novel solutions designed from predictions using the three-pore model were investigated. In group A ([Na+] = 115 mmol/l), the glucose (G) was increased to 2.0% to compensate for reduced osmolality whereas in group B ([Na+] = 102 mmol/l), it was unchanged (2.5%). Both solutions were substituted for one 3- to 5-h exchange per day and no change was made to the rest of the dialysis regime.

Results. Ten patients in group A and 15 in group B completed the study. Both solutions resulted in significant increases (30–50 mmol/dwell) in diffusive sodium removal during the test exchanges, P < 0.001. Ultrafiltration was maintained in group A but reduced in group B. Ambulatory nocturnal mean BP fell in group A [93.1 ± 10.6 mmHg (±SD) versus 85.1 ± 10.2 mmHg, P < 0.05], but was stable in group B (95.4 ± 9.4 versus 95.1.1 ± 10.7 mmHg, NS). Thirst reduced independent of appetite and mood in both groups by 2 months, more markedly in group A. Indices of fluid status, including TBW by bioimpedance and D dilution also improved in group A, P < 0.05, whereas weight increased in group B.

Conclusions. Increasing the diffusive component of sodium removal whilst maintaining ultrafiltration is associated with improvements in BP, thirst and fluid status. The lack of effect seen with uncompensated low-sodium dialysate suggests that these benefits cannot be achieved by manipulation of dialysate sodium removal alone. These observations provide valuable information of the design of future randomized studies to establish the clinical role for low-sodium dialysis fluids.

Keywords: bioimpedance; blood pressure; deuterium; fluid status; thirst

Received for publication: 2. 9.08
Accepted in revised form: 5.11.08


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