Abstract: SA-PO358
Dialysate Sodium and the Risk of Intradialytic Hypertension: A Post Hoc Analysis of a Randomized Controlled Trial
Session Information
- Hemodialysis and Frequent Dialysis: CV and Risk Prediction
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Del Castillo Rix, Daniel Sebastian, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Georgiadis, Despina, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Singh, Anika T., Brigham and Women's Hospital, Boston, Massachusetts, United States
- McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Higher dialysate sodium (DNa) concentrations are sometimes utilized to manage intradialytic hypotension. However, higher DNa has also been associated with thirst, inter-dialytic weight gain, and higher blood pressure (BP). Few studies have evaluated the risk of intra-dialytic hypertension (IDHyper) with higher DNa, especially among hospitalized hemodialysis (HD) patients.
Methods
We performed a post-hoc analysis of a double-blinded single center, randomized controlled trial (NCT02145260) in hospitalized patients on maintenance hemodialysis (N=139) that randomized patients to higher (142 mmol/L) vs. lower (138 mmol/L) DNa for up to six sessions. BP was measured pre-HD, every 15 minutes intra-HD, and post-HD. Mixed effects Poisson regression models were fit to assess the effect of higher vs. lower DNa on the rate of IDHyper, defined as any increase in systolic BP (SBP) from pre-HD to post-HD. Additional models were considered that adjusted for imbalances in baseline characteristics (SBP, sex, heart failure and pre-HD weight).
Results
139 patients (305 study visits) were included in the present analyses. A total of 125 (41%) sessions were complicated by IDHyper. Using an intention-to-treat approach, there was no significant difference in rates of IDH for higher vs. lower DNa arms (IRR 1.17; 95% confidence interval (CI) 0.82,1.66). Effect estimates were accentuated in the adjusted models but did not reach statistical significance (IRR 1.60; 95% CI 0.95,2.70). A sensitivity analysis, where IDHyper was defined as SBP increase ≥10 mmHg from pre- to post-HD had similar patterns of association in the intent-to-treat (IRR 1.16; 95% CI 0.71,1.92) and adjusted analyses (1.50; 95% CI 0.74,3.04).
Conclusion
In this post-hoc analysis of a DNa trial in hospitalized HD patients, we found no significant difference in rates of IDHyper for higher vs. lower DNa. As effect estimates were accentuated in fully adjusted analyses, larger studies are needed to investigate the possible association of higher DNa with IDHyper in this population.
Funding
- NIDDK Support