Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Jun 23;37(7):1340-1347.
doi: 10.1093/ndt/gfab329.

A randomized controlled trial of two dialysate sodium concentrations in hospitalized hemodialysis patients

Finnian R Mc Causland  1   2 , Katherine Scovner Ravi  1   2 , Katherine A Curtis  1   2 , Zoé A Kibbelaar  3   4 , Samuel A P Short  5 , Anika T Singh  1   2 , Simon Correa  1   2 , Sushrut S Waikar  3   4
Affiliations
Randomized Controlled Trial

A randomized controlled trial of two dialysate sodium concentrations in hospitalized hemodialysis patients

Finnian R Mc Causland et al. Nephrol Dial Transplant. .

Abstract

Background: Several large dialysis organizations have lowered the dialysate sodium concentration (DNa) in an effort to ameliorate hypervolemia. The implications of lower DNa on intra-dialytic hypotension (IDH) during hospitalizations of hemodialysis (HD) patients is unclear.

Methods: In this double-blind, single center, randomized controlled trial (RCT), hospitalized maintenance HD patients were randomized to receive higher (142 mmol/L) or lower (138 mmol/L) DNa for up to six sessions. Blood pressure (BP) was measured in a standardized fashion pre-HD, post-HD and every 15 min during HD. The endpoints were: (i) the average decline in systolic BP (pre-HD minus lowest intra-HD, primary endpoint) and (ii) the proportion of total sessions complicated by IDH (drop of ≥20 mmHg from the pre-HD systolic BP, secondary endpoint).

Results: A total of 139 patients completed the trial, contributing 311 study visits. There were no significant differences in the average systolic blood pressure (SBP) decline between the higher and lower DNa groups (23 ± 16 versus 26 ± 16 mmHg; P = 0.57). The proportion of total sessions complicated by IDH was similar in the higher DNa group, compared with the lower DNa group [54% versus 59%; odds ratio 0.72; 95% confidence interval (95% CI) 0.36-1.44; P = 0.35]. In post hoc analyses adjusting for imbalances in baseline characteristics, higher DNa was associated with 8 mmHg (95% CI 2-13 mmHg) less decline in SBP, compared with lower DNa. Patient symptoms and adverse events were similar between the groups.

Conclusions: In this RCT for hospitalized maintenance of HD patients, we found no difference in the absolute SBP decline between those who received higher versus lower DNa in intention-to-treat analyses. Post hoc adjusted analyses suggested a lower risk of IDH with higher DNa; thus, larger, multi-center studies to confirm these findings are warranted.

Keywords: blood pressure; chronic hemodialysis; hemodialysis; hypotension; intradialytic hypotension.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Enrollment flow chart. CNS, central nervous system.
Figure 2:
Figure 2:
Mean SBP according to randomized treatment arm.
See this image and copyright information in PMC

References

    1. Zoccali C, Torino C, Tripepi Ret al. . Pulmonary congestion predicts cardiac events and mortality in ESRD. J Am Soc Nephrol 2013; 24: 639–646 - PMC - PubMed
    1. Flythe JE, Xue H, Lynch KEet al. . Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol 2015; 26: 724–734 - PMC - PubMed
    1. Dinesh K, Kunaparaju S, Cape Ket al. . A model of systolic blood pressure during the course of dialysis and clinical factors associated with various blood pressure behaviors. Am J Kidney Dis 2011; 58: 794–803 - PubMed
    1. Keane DF, Raimann JG, Zhang Het al. . The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality. Kidney Int 2021; 99: 1408–1417, - PMC - PubMed
    1. Causland FRM, Brunelli SM, Waikar SS. Dialysis dose and intradialytic hypotension: results from the HEMO study. Am J Nephrol 2013; 38: 388–396 - PMC - PubMed

Publication types