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Abstract: PO2635

A Randomized Controlled Trial of Dialysate Sodium in Hospitalized Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Scovner, Katherine Mikovna, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Curtis, Katherine, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Kibbelaar, Zoé A., Harvard Medical School, Boston, Massachusetts, United States
  • Short, Samuel, University of Vermont College of Medicine, Burlington, Vermont, United States
  • Singh, Anika T., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Correa, Simon, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston University, Boston, Massachusetts, United States
Background

Several large dialysis organizations have lowered the dialysate sodium concentration (DNa) in an effort to ameliorate hypervolemia. The implications of lower DNa on intra-dialytic hypotension (IDH) during hospitalizations of hemodialysis (HD) patients is unclear.

Methods

In this double-blind single center randomized controlled trial, hospitalized maintenance HD patients were randomized to receive higher (142 mmol/L) or lower (138 mmol/L) DNa for up to six sessions. Blood pressure (BP) was measured in a standardized fashion pre-HD, post-HD and every 15 minutes during HD. The primary endpoints were: 1) the average decline in systolic BP; and 2) the proportion of total sessions complicated by IDH (defined as a drop of ≥20 mmHg from the pre-HD SBP).

Results

A total of 139 patients completed the trial, contributing 311 study visits (Table 1). There were no significant differences in the average SBP decline between the higher and lower DNa groups (23 ±16 vs. 26 ±16 mmHg; P=0.31). The proportion of total sessions complicated by IDH was similar in the higher DNa group compared with the lower DNa group (54% vs. 59%; OR 0.72; 95%CI 0.36 to 1.44; P=0.35). In post-hoc analyses adjusting for imbalances in baseline characteristics, higher DNa was associated with an 8 mmHg (95%CI 2 to 14 mmHg) lesser decline in SBP, compared with lower DNa.

Conclusion

In this RCT for hospitalized maintenance HD patients, we found no difference in the absolute SBP decline between those who received higher versus lower DNa. Larger multi-center studies to confirm these findings are warranted.

Table 1
CharacteristicLower DNa 138 mmol/L
(n=69)
Higher DNa 142 mmol/L
(n=70)
Age (yrs)61 ± 1458 ± 15
Male (n, %)43 (62%)36 (51%)
Black (n, %)21 (30%)25 (36%)
Diabetes (n, %)36 (52%)39 (56%)
Heart Failure (n, %)28 (43%)21 (32%)
Catheter Access (n, %)16 (23%)14 (20%)
Pre-HD SBP (mmHg)135 ± 24139 ± 24
Pre-HD Weight (kg)80.4 ± 23.273.3 ± 21.6
Serum Sodium (mmol/L)137 ± 4137 ± 3
Blood Urea Nitrogen (mg/dL)49 ± 1948 ± 17
Hemoglobin (g/dL)9.6 ± 1.59.5 ± 1.5

Funding

  • NIDDK Support