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Kidney Week

Abstract: PO1086

Low Sodium Dialysate for Hemodialysis Is Associated with Lower Blood Pressure and Interdialytic Weight Gain, but Not a Lower Pre-Dialysis Serum Sodium

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Nguyen, Huyen, University of California Davis, Sacramento, California, United States
  • Chin, Andrew I., University of California Davis, Sacramento, California, United States
Background

The use of high dialysate sodium (NaD) concentrations for hemodialysis (HD) is associated with greater interdialytic fluid gain (IDWG). The association with higher blood pressure has not been found routinely. Conversely, use of a lower NaD may improve on these parameters, but may lead to a lower pre-dialysis serum sodium concentration, which may have adverse consequences in this population. We aimed to examine IDWG, blood pressure, calculated serum osmolality and serum Na in HD patients on a high NaD (145) who transitioned to a low NaD (137-138)

Methods


In this retrospective, single-center study of 3-times weekly HD patients without residual kidney function, we queried long-term HD patients who were prescribed NaD of 145 and were then switched to a NaD of 137 or 138, based on change in standard clinic dialysate sodium. Parameters investigated included: pre-HD serum Na and albumin, calculated pre-HD serum osmolality, pre and post-HD weights, and pre and post-HD blood pressures. Paired T-test was used for comparison of each parameter betwee dialysate time periods.

Results

We identified 136 patients who were started on HD with NaD of 145 for at least 1 year, subsequently changed to a NaD of 137-138 for at least 1 additional year. See Figure comparison of parameters.

Conclusion

In patients on 3-times a week HD, long-term use of a high NaD of 145, compared to a low NaD of 137-138, was associated with a higher IDWG, similar to what is found in other studies. A lower NaD was associated with lower pre and post-HD systolic and diastolic blood pressures, but we found no difference in pre-HD serum Na or calculated serum osmolality. The degree of drop in blood pressure during HD on the low NaD caused hypotensive events in some patients. There are some clinical parameter benefits to a lower NaD and serum Na does not appear to suffer.

Table 1. Paired T-test comparison of averaged parameters during low and high dialysate sodium HD

Funding

  • Clinical Revenue Support