Outcome of individualized dialysate sodium concentration for hemodialysis patients

Abstract EN

To evaluate the individualization of dialysate sodium (Na +) concentration in hemodialysis (HD), we studied 40 stable chronic HD patients in a single-blind crossover design.

They underwent 36 consecutive HD sessions with the dialysate Na + concentration set at 138 mmol / L, followed by 36 sessions of dialysate Na + set to match the patients average pre-HD plasma Na + levels.

We multiplied the midweek pre-HD measured Na + by the Donnan coefficient of 0.95 (individualized Na +).

Pre-HD Na + dialysis sodium levels were nearly constant, with no variation between the two phases and a mean of 137.45 ± 2.04 mmol / L.

Post-HD serum Na + was significantly higher during the standard phase (139.7 ± 2 mmol / L) than during the individualized phase (137.1 ± 1.6 mmol / L).

Also, interdialytic weight gain (IDWG) was significantly more reduced during the individualized phase (3.25 ± 0.56 %) than during the standard phase (3.94 ± 0.92 %), P < 0.001.

Episodes of distressing symptoms including headache, muscle cramps and hypotension were significantly less frequent in the individualized phase.

The mean of the pre-HD and post-HD systolic and diastolic blood pressures significantly decreased during the individualized phase, and we could reduce the doses of antihypertensive drugs in 10 (33.33 %) patients.

Individualized dialysate Na + concentration was associated with a decrease in IDWG and dialysis hypotension and related symptoms and better BP control in stable chronic HD patients.