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Individualized reduction in dialysate sodium in conventional in‐center hemodialysis
Author(s) -
Arramreddy Rohini,
Sun Sumi J.,
Munoz Mendoza Jair,
Chertow Glenn M.,
Schiller Brigitte
Publication year - 2012
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00701.x
Subject(s) - medicine , hemodialysis , blood pressure , weight gain , medical prescription , cardiology , anesthesia , body weight , surgery , pharmacology
Recent studies have focused on the association between dialysate sodium ( Na + ) prescriptions and interdialytic weight gain ( IDWG ). We report on a case series of 13 patients undergoing conventional, thrice‐weekly in‐center hemodialysis with an individualized dialysate Na + prescription. Individualized dialysate Na + was achieved in all patients through a stepwise weekly reduction of the standard dialysate Na + prescription (140 m E q/ L ) by 2–3 m E q/ L until reaching a Na + gradient of −2 m E q/ L (dialysate Na + minus average plasma Na + over the preceding 3 months). Interdialytic weight gain, with and without indexing to dry weight ( IDWG %), blood pressure, and the proportion of treatments with cramps, intradialytic hypotension (drop in systolic blood pressure >30 mm H g) and intradialytic hypotension requiring an intervention were reviewed. At the beginning of the observation period, the pre‐hemodialysis (HD) plasma Na + concentration ranged from 130 to 141 m E q/ L . When switched from the standard to the individualized dialysate Na + concentration, IDWG % decreased from 3.4% ± 1.6% to 2.5% ± 1.0% ( P = 0.003) with no change in pre‐ or post‐ HD systolic or diastolic blood pressures (all P > 0.05). We found no significant change in the proportion of treatments with cramps (6% vs. 13%), intradialytic hypotension (62% vs. 65%), or intradialytic hypotension requiring an intervention (29% vs. 33%). Individualized reduction of dialysate Na + reduces IDWG % without significantly increasing the frequency of cramps or hypotension.