Effect of cool dialysate and sodium profiling on intradialytic hypotension and their effect on urea kinetics

Abstract EN

Background : Intra-dialytic hypotension (IH) is a common adverse event that occurs in 20 to30 % of all hemodialysis (HD) treatment.

A variety of methods have been tested in order to prevent hypotensive episodes during HD sessions, as high dialysate sodium, sodium profiling and cool dialysate but no conclusive results have been drawn yet.

This work aimed to study the effect of cool dialysate and / or sodium profiling as preventive methods for IH in HD patients and their effect on urea kinetics.

Methods : The study included twenty chronic renal failure patients (CRF) on HD for at least 6 months characterized by having frequent episodes of hypotension during dialysis.

Patients were subjected to the following protocols : one month on dialysis with dialysate at 37oC ,one month on cool dialysate at 35oC, one month on sodium profiling, in which the dialysate sodium concentration declined gradually from 145mEq / L to 135mEq / L during each session and one month on both cool dialysate and sodium profiling.

All patients were subjected to: Full clinical examination with special stress on measuring blood pressure and calculation of the mean arterial blood pressure (MAP) pre-dialysis, hourly during dialysis and post dialysis, Laboratory investigations including: complete blood picture, blood urea nitrogen (BUN), serum creatinine, urea reduction ratio [URR] and Kt / V at the start and the end of each month, Echocardiography for measuring the cardiac output (COP) pre and post dialysis at the start and at the end of each month, A questionnaire to study the patient’s perception about cool dialysate.

Results : The studied patients were 11 males and 9 females, their mean age was 45.20 ±12.2 years and the mean duration of dialysis was 6.89 ± 5.7 years.

Their mean hemoglobin level was 10.44 mg / dl.

The number of hypotension episodes per session was significantly fewer when the patients were dialyzed on both sodium profiling and cool-temperature dialysis as compared with the standard dialysis and with each procedure alone (P<0.01).

The MAP was significantly preserved on cool-temperature dialysis and sodium profiling as compared with standard dialysis.

MAP was significantly higher with both cool dialysate and sodium profiling as compared with each maneuver alone or with standard dialysis (P<0.01).

There was no significant difference in the mean level of BUN, serum creatinine, URR and Kt / V at the start and the end of each month.

The COP decreased significantly less during therapy with cool dialysate or sodium profiling compared with standard dialysis.

Seventeen patients (85%) reported feeling more energetic with a dramatic improvement in their general health following dialysis with cool dialysate.

Conclusion : We conclude that, cool dialysate and sodium profiling are effective prevention methods for IH without compromising the efficacy of HD.

The combination of both maneuvers gave better results for prevention of IH.

Patient’s perception of being dialyzed with cool dialysate reflected a positive response.