Abstract: SA-PO908
Individualizing Dialysate Sodium Concentrations to Improve Fluid Management in Chronic Dialysis Patients: A Prospective, Nonrandomized, Open-Label Trial
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ramaswamy, Kavitha, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Xia, Jin, Indiana University, Indianapolis, Indiana, United States
- Song, Yiqing, Indiana University, Indianapolis, Indiana, United States
- Zhang, JingJing, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Background
Excessive fluid is associated with increased morbidity and mortality in patients on chronic dialysis. Excessive fluid measured as excessive interdialytic weight gain (EIDWG)% and above target weight (ATW)% in our dialysis unit reached nearly 50% of our patients despite interventions such as dietary counseling. We thus conducted a nonrandomized, open-label trial of 73 patients undergoing hemodialysis to explore the benefit of an individualized Na prescription.
Methods
Patients in the individualized Na group (n=33) received lower dialysate Na (135-137mmol/L) if their serum Na level<138 mmol/L, predialysis systolic blood pressure (SBP) >120 mmHg, and EIDWG% and ATW% being higher than the goal levels. Forty patients who used the standard dialysate Na at 138 mmol/L were considered the control group. All the variables were collected before and 2 months after intervention. We used student t tests to compare continuous variables between two groups. Multivariate-adjusted linear regression models were performed to assess the differences in each continuous outcome between two groups with adjustment for age and sex. Multivariable logistic regression models were conducted by modeling IDWG decrease and ATW decrease as dependent variables, adjusting for age, sex, and EDW change. All p values will be two-tailed. All statistical analyses were performed using SAS software, version 9.4 (SAS Institute, Cary, NC).
Results
Overall, such a moderate reduction of dialysate Na concentration was well tolerated. The SBP in patient group with individualized dialysate Na did not change from before intervention. Elevation in serum Na in the individualized dialysate Na group was significantly higher than that in the control group by 3.54 mmol/L (95% CI, 2.02 to 5.05) (P<0.0001), which may indicate the improvement of volume status. Patients with individualized dialysate Na were 3.50 times more likely to have IDWG decrease. The significant association remained after adjustment for age, sex, and EDW changes (OR:3.63; 95% CI, 1.03-12.9).
Conclusion
Our preliminary results showed that individualized dialysate Na prescription in patients on chronic dialysis is safe and well-tolerated and may be effective in the fluid management in hemodialysis patients. Future randomized controlled trials are warranted.