Dialysate sodium and sodium gradient in maintenance hemodialysis: a neglected sodium restriction approach? NEPHROLOGY DIALYSIS TRANSPLANTATION Mendoza, J. M., Sun, S., Chertow, G. M., Moran, J., Doss, S., Schiller, B. 2011; 26 (4): 1281-1287


A higher sodium gradient (dialysate sodium minus pre-dialysis plasma sodium) during hemodialysis (HD) has been associated with sodium loading; however, its role is not well studied. We hypothesized that a sodium dialysate prescription resulting in a higher sodium gradient is associated with increases in interdialytic weight gain (IDWG), blood pressure (BP) and thirst.We conducted a cross-sectional study on 1084 clinically stable patients on HD. A descriptive analysis of the sodium prescription was performed and clinical associations with sodium gradient were analyzed.The dialysate sodium prescription varied widely across dialysis facilities, ranging from 136 to 149 mEq/L, with a median of 140 mEq/L. The mean pre-HD plasma sodium was 136.7 ± 2.9 mEq/L, resulting in the majority of subjects (n = 904, 83%) being dialyzed against a positive sodium gradient, while the mean sodium gradient was 4.6 ± 4.4 mEq/L. After HD, the plasma sodium increased in nearly all patients (91%), reaching a mean post-HD plasma sodium of 141.3 ± 2.5 mEq/L. We found a direct correlation between IDWG and sodium gradient (r = 0.21, P < 0.0001). After adjustment for confounders and clustering by facilities, the sodium gradient was independently associated with IDWG (70 g/mEq/L, P < 0.0001). There were no significant associations among sodium gradient and BP, whether measured as pre-HD systolic (r =?-0.02), diastolic (r =?-0.06) or mean arterial pressure (r =?-0.04). Post-HD thirst was directly correlated with sodium gradient (r = 0.11, P = 0.02).Sodium gradient is associated with statistically significant and clinically meaningful differences in IDWG in stable patients on HD.

View details for DOI 10.1093/ndt/gfq807

View details for Web of Science ID 000289309400026

View details for PubMedCentralID PMC3108351