Kidney Week

Abstract: SA-PO414

Hemodynamic Impact of High- vs. Low-Sodium Dialysate Concentrations in Patients with ESKD on Hemodialysis: A Crossover Clinical Trial

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Muñoz, Diana Laura, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico

Diana Laura Muñoz

• Sanchez, Diana Noemi, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jalisco, Mexico

Diana Noemi Sanchez

• Banda Lopez, Adriana, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico

Adriana Banda Lopez, MD

• Mendoza Cabrera, Salvador, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jalisco, Mexico

Salvador Mendoza Cabrera, MD

• Castro, Caren, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico

Caren Castro, MD

• Andrade-Sierra, Jorge, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico

Jorge Andrade-Sierra, MD, PhD

• Rojas-Campos, Enrique, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jalisco, Mexico

Enrique Rojas-Campos, MD

• Cruz Landino, Moises, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jalisco, Mexico

Moises Cruz Landino, MD

• Parra Guerra, Ricardo, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jalisco, Mexico

Ricardo Parra Guerra, MD

Group or Team Name

• Servicio de Nefrología y Trasplante, Hospital de Especialidades Centro Médico Nacional de Occidente, México.

Background

The prescription of sodium dialysate concentration in the hemodialysis (HD) setting remains controversial. The aim of this study is to evaluate the hemodynamic impact of high versus low sodium dialysate concentrations in prevalent HD patients

Methods

A crossover clinical trial was conducted in chronic HD patients at one tertiary care center. Patients were randomized 1:1 into two arms: (1) dialysate sodium 135 mEq/L, and (2) dialysate sodium 145 mEq/L for 4 weeks, and a washout period with dialysate sodium at 138 mEq/L for 2 weeks. Figure 1 summarizes methods. Interdialytic weight gain (IDWG), blood pressure (BP), plasma sodium concentration, and C-reactive protein (CRP) concentrations were measured before and after each phase. Self-administered questionnaires were used to assess dialysis disequilibrium symptoms in each HD session.

Results

27 patients were enrolled: 55% women, mean age: 37.5 ± 12.5 years, and mean time on HD: 7.6 ± 6.5 years. Main vascular access was arteriovenous fistula in 23 patients (79%), antihypertensive drugs were used by 15 patients (59%). The average BP at the beginning and end of each phase showed no statistically significant difference. The dialysate sodium prescription of 145 mEq/L showed an increase in CRP values (p = 0.004) and IDWG (p = 0.02), and showed a significant increase in thirst and edema.

Conclusion

Low sodium dialysate does not confer greater hemodynamic instability. This approach could reduce inter and intradialytic disequilibrium symptoms, as well as systemic inflammation.

Figure 1 Study Methods

Figure 2 Results