TY - JOUR
T1 - Effect of lowering dialysate sodium concentration on interdialytic weight gain and blood pressure in patients undergoing thrice-weekly in-center nocturnal hemodialysis
T2 - A quality improvement study
AU - Munoz Mendoza, Jair
AU - Bayes, Liz Y.
AU - Sun, Sumi
AU - Doss, Sheila
AU - Schiller, Brigitte
N1 - Funding Information:
We thank the dedicated staff of the in-center nocturnal hemodialysis program, who provide excellent quality care, and our patients, who have entrusted themselves to our care and taught us more about end-stage renal disease than textbooks possibly could. Support: Dr Schiller, Ms Sun, and Ms Doss are employees of Satellite Healthcare. During his fellowship at Stanford University, Dr Munoz Mendoza was the recipient of the Satellite Hans Wolf Research fellowship award. Financial Disclosure: The authors declare that they have no other relevant financial interests.
PY - 2011/12
Y1 - 2011/12
N2 - Background: Patients on in-center nocturnal hemodialysis therapy typically experience higher interdialytic weight gain (IDWG) than patients on conventional hemodialysis therapy. We determined the safety and effects of decreasing dialysate sodium concentration on IDWG and blood pressure in patients on thrice-weekly in-center nocturnal hemodialysis therapy. Study Design: Quality improvement, pre-post intervention. Settings & Participants: 15 participants in a single facility. Quality Improvement Plan: Participants underwent three 12-week treatment phases, each with different dialysate sodium concentrations, as follows: phase A, 140 mEq/L; phase B, 136 or 134 mEq/L; and phase A +, 140 mEq/L. Participants were blinded to the exact timing of the intervention. Outcomes: IDWG, IDWG/dry weight (IDWG%), and blood pressure. Measurements: Outcome data were obtained during the last 2 weeks of each phase and compared with mixed models. The fraction of sessions with adverse events (eg, cramping and hypotension) also was reported. Results: IDWG, IDWG%, and predialysis systolic blood pressure decreased significantly by 0.6 ± 0.6 kg, 0.6% ± 0.8%, and 8.3 ± 14.9 mm Hg, respectively, in phase B compared with phase A (P < 0.05 for all comparisons). No differences in predialysis diastolic and mean arterial or postdialysis blood pressures were found (P > 0.05 for all comparisons). The proportion of treatments with intradialytic hypotension was low and similar in each phase (P = 0.9). In phase B compared with phase A, predialysis plasma sodium concentration was unchanged (P > 0.05), whereas postdialysis plasma sodium concentration decreased by 3.7 ± 1.9 mEq/L (P < 0.05). Limitations: Modest sample size. Conclusion: Decreasing dialysate sodium concentrations in patients undergoing thrice-weekly in-center nocturnal hemodialysis resulted in a clinical and statistically significant decrease in IDWG, IDWG%, postdialysis plasma sodium concentration, and predialysis systolic blood pressure without increasing adverse events. Prolonged exposure to higher than required dialysate sodium concentrations may drive IDWG and counteract some of the purported benefits of "go-slow" (longer session length) hemodialysis.
AB - Background: Patients on in-center nocturnal hemodialysis therapy typically experience higher interdialytic weight gain (IDWG) than patients on conventional hemodialysis therapy. We determined the safety and effects of decreasing dialysate sodium concentration on IDWG and blood pressure in patients on thrice-weekly in-center nocturnal hemodialysis therapy. Study Design: Quality improvement, pre-post intervention. Settings & Participants: 15 participants in a single facility. Quality Improvement Plan: Participants underwent three 12-week treatment phases, each with different dialysate sodium concentrations, as follows: phase A, 140 mEq/L; phase B, 136 or 134 mEq/L; and phase A +, 140 mEq/L. Participants were blinded to the exact timing of the intervention. Outcomes: IDWG, IDWG/dry weight (IDWG%), and blood pressure. Measurements: Outcome data were obtained during the last 2 weeks of each phase and compared with mixed models. The fraction of sessions with adverse events (eg, cramping and hypotension) also was reported. Results: IDWG, IDWG%, and predialysis systolic blood pressure decreased significantly by 0.6 ± 0.6 kg, 0.6% ± 0.8%, and 8.3 ± 14.9 mm Hg, respectively, in phase B compared with phase A (P < 0.05 for all comparisons). No differences in predialysis diastolic and mean arterial or postdialysis blood pressures were found (P > 0.05 for all comparisons). The proportion of treatments with intradialytic hypotension was low and similar in each phase (P = 0.9). In phase B compared with phase A, predialysis plasma sodium concentration was unchanged (P > 0.05), whereas postdialysis plasma sodium concentration decreased by 3.7 ± 1.9 mEq/L (P < 0.05). Limitations: Modest sample size. Conclusion: Decreasing dialysate sodium concentrations in patients undergoing thrice-weekly in-center nocturnal hemodialysis resulted in a clinical and statistically significant decrease in IDWG, IDWG%, postdialysis plasma sodium concentration, and predialysis systolic blood pressure without increasing adverse events. Prolonged exposure to higher than required dialysate sodium concentrations may drive IDWG and counteract some of the purported benefits of "go-slow" (longer session length) hemodialysis.
KW - dialysate sodium
KW - hypertension
KW - interdialytic weight gain
KW - Nocturnal hemodialysis
KW - sodium gradient
KW - sodium set point
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U2 - 10.1053/j.ajkd.2011.06.030
DO - 10.1053/j.ajkd.2011.06.030
M3 - Article
C2 - 21875769
AN - SCOPUS:81755177465
VL - 58
SP - 956
EP - 963
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 6
ER -