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KMID : 0607119990050020295
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Inha Medical Journal
1999 Volume.5 No. 2 p.295 ~ p.301
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Effects of Step-down Sodium Profiling in Chronic Hemodialysis Patients
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Kim Moon-Jae
Kwon Kun-Ho
Lee Seoung-Woo
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Abstract
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Hemodialysis(HD) is frequently complicated by hypotension, muscle cramps, headaches, nausea, and vomiting in the intradialytic period and by fatigue and thirst in the interdialytic period. These symptoms diminish the quality of life in HD patients. Hypotension and muscle cramp have been attributed to depletion of intravascular volume, and headache and fatigue have been attributed to disequilibrium induced by rapid change in intra- and extracellular osmolality. Sodium profiling (SP) is a computerized programmed dialysate sodium concentration as a means of optimizing dialysis therapy. We examined the beneficial effects of SP in chronic 20 HD patients suffering from intradialytic hypotension, muscle cramp, nausea, and headache and to find out the interdialytic effects of SP. The patients were medically stable and had more
than 2 episodes of intradialytic hypotension (SBP<90 ㎜Hg or decrease >30 ㎜Hg than predialysis), muscle cramp, nausea, or headache during recent 2 months before study. Conventional low sodium dialysis during the first 4 weeks (Period A:135 mEq) and step-down sodium profiling during the second 4 weeks (Period B:150 mEq for 2∼3 hours 140 mEq for 1 hour 138 mEq for 1 hour) were done. 1. The mean age was 52.7±12.8 years and sex ratio was 1:3. Diabetics were 8 cases (40%). 2. The frequency of intradialytic hypotension was 34.3±35.2% in period A and 15.1± 17.6% during period B (p<0.01) and the frequency of saline administration was significantly less during period B than period A (15.4±24.0 vs.0.8±2.5%, p<0.01). 3. There was a tendancy that intradialytic muscle cramps (14.2±24.6 vs. 8.3±14.8%, p=0.12) and nausea (10.3±13.5 vs. 5.2±6.3%, p=0.06) were less in period B, but there were no differences in the frequency of headache, fatigue, and dizziness between two groups. 4. Interdialytic weight jai (2.53 ±0.73 vs. 2.98±0.66 ㎏, p=0.001), ultrafiltration amount (2.56±0.75 vs. 3.00±0.66 L, p<0.001) and interdialytic thirst (29.6±33.1 vs. 63.0±41.2%, p<0.001) were more frequent in period B than period A. 5. Predialysis systolic and diastolic pressure and postdialytic diastolic pressure were
not different between two periods, but postdialytic systolic pressure was higher during period B than A (148.6 ± 22.9 vs. 159.2± 20.2 ㎜Hg, p<0.05). 6. Predialysis plasma osmolality was not different between two periods, but postdialysis plasma osmolality was higher in period B than in period A (297.6±5.1 vs. 300.5±3.7 mOsm/㎏·H2O, p<0.01). Pre- and postdialytic plasma sodium concentrations were lower in period A than in period B (134.9±3.8 and 135.9±1.9 vs.
137.1±3.5 and 139.9±2.2 mEq/L, p<0.001). The difference of osmolality between pre- and postdialysis was lower in period B than in period A (-11.5±5.4 vs. -16.7±6.8, p<0.05) and the difference of sodium concetration between pre- and postdialysis was higher in period B than in period A (2.8 ±2.1 vs. 1.0±3.0, p<0.05). There was no difference in the degree of hemoconcentration between two periods. In conclusion, programmed step-down sodium profiling of dialysate is a effective method in decreasing osmotic disequilibrium syndrome, hypotension and muscle cramps and is beneficial to dialysis patients.
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KEYWORD
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Sodium profiling, Hemodialysis, Hypotension
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