A Comparative Study of the Effect of Fixed Versus Individualized Dialysate Sodium Levels on Blood Pressure and Interdialytic Weight Gain in Chronic Kidney Disease Patients on Maintenance Hemodialysis

Abstract

Authors Dr Pulipati Akshaya Chowdary, Dr Sanju Rajappan* Department of Medicine, PES Institute of Medical Sciences & Research Kuppam 517425, A.P., India *Corresponding Author Dr Sanju Rajappan Department of Nephrology, Malabar Medical College, Modakkallur, Calicut, Kerala 673323, India Abstract Hypertension is common in end-stage renal disease patients and accelerates cardiovascular morbidity and mortality. An important measure in achieving normal blood pressure in these patients is reaching the target dry weight. Sodium and extracellular fluid balance play a major role in blood pressure and interdialytic weight gain. Serum sodium levels have a role in both maintaining blood pressure and inter dialytic weight gain .Sodium concentration of the dialysate is critical in maintaining the serum sodium of the patient on dialysis and in ultra-filtrate removal. The standard method of single sodium level of dialysate for all patients ignores the interand intra-individual variability of serum sodium. The need for a study to assess the blood pressure changes using standard sodium in the dialysate and varying the sodium in the dialysate as per the pre hemodialysis serum sodium levels of the patient was anticipated. In this study we try to address such a concern. 30 patient on regular maintenance hemodialysis participated in the study, they underwent dialysis with standard levels of sodium (137meq/l) for 4 weeks, later for the next 4 weeks they underwent dialysis with a dialysate sodium level that was adjusted as per their pre hemodialysis serum sodium. The mean blood pressure during dialysis were 150.3 mm Hg in the standard group and 148.3 mm Hg in the individualized group. The mean intradialytic weight gain in the standardized group was 3.05 kg and in the individualized group was 3.02kg. The results did not show any significant difference in changes in blood pressure or inter dialytic weight gain.