Abstract
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 (140mEq/L) by 2-3mEq/L until reaching a Na+ gradient of -2mEq/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 >30mmHg) 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 141mEq/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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 473-480 |
| Number of pages | 8 |
| Journal | Hemodialysis International |
| Volume | 16 |
| Issue number | 4 |
| DOIs | |
| State | Published - 2012 |
| Externally published | Yes |
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Keywords
- Dialysate sodium
- Hemodialysis
- Individualized dialysate sodium
- Interdialytic weight gain
- Sodium gradient
ASJC Scopus subject areas
- Hematology
- Nephrology
Cite this
Individualized reduction in dialysate sodium in conventional in-center hemodialysis. / Arramreddy, Rohini; Sun, Sumi J.; Munoz Mendoza, Jair; Chertow, Glenn M.; Schiller, Brigitte.
In: Hemodialysis International, Vol. 16, No. 4, 2012, p. 473-480.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Individualized reduction in dialysate sodium in conventional in-center hemodialysis
AU - Arramreddy, Rohini
AU - Sun, Sumi J.
AU - Munoz Mendoza, Jair
AU - Chertow, Glenn M.
AU - Schiller, Brigitte
PY - 2012
Y1 - 2012
N2 - 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 (140mEq/L) by 2-3mEq/L until reaching a Na+ gradient of -2mEq/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 >30mmHg) 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 141mEq/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.
AB - 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 (140mEq/L) by 2-3mEq/L until reaching a Na+ gradient of -2mEq/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 >30mmHg) 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 141mEq/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.
KW - Dialysate sodium
KW - Hemodialysis
KW - Individualized dialysate sodium
KW - Interdialytic weight gain
KW - Sodium gradient
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U2 - 10.1111/j.1542-4758.2012.00701.x
DO - 10.1111/j.1542-4758.2012.00701.x
M3 - Article
VL - 16
SP - 473
EP - 480
JO - Hemodialysis International
JF - Hemodialysis International
SN - 1492-7535
IS - 4
ER -