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KMID : 1128620100140010029
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Cung-Ang Journal of Nursing
2010 Volume.14 No. 1 p.29 ~ p.37
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The Effects of Individualized dialysate sodium concentration in hemodialysis patient’s blood pressure, interdialytic weight gain and thirst
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Won Sam-Soon
Yun Hyun-Jeong
Cho Sung-Lee
Lee Se-Young
Lee Gyeong-Eun
Park Mi-Ju
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Abstract
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Purpose: Current hemodialysis prescribing standards use dialysate sodium concentration that are high relative
to the patient’s plasma sodium concentration. Generally each patient has a fixed osmolar set point. So, use of hypertonic
sodium dialysate predispose to positive sodium balance, lead to higher blood pressure, interdialytic weight gain and thirst. Therefore, we designed a study to investigate the effects of individualized dialysate sodium concentration prescription based on pre-HD plasma sodium concentration on patient’s blood pressure, interdialytic weight gain and thirst.
Methods: Thirty-eight HD patients were enrolled in this cross-over study. All the patients underwent nine
consecutive HD sessions with the dialysate contained 138 mEq/L sodium (standard sodium HD), then concentrations
of sodium were switched to match the patients average pre-HD plasma sodium measured during the sodium standard phase (135mEq/L for patients with sodium levels less than 130mEq/L, 137mEq/L for patients with sodium levels over 138mEq/L).
Results: Standard sodium dialysis and individualized sodium alignment of the physiological indices Hgb, Hct,
Calcium, Kt / V, BUN, Cr and there were no differences, There was a significant decrease in the interdialytic weight gain (2.3 ± 0.8kg vs. 2.0 ± 0.8kg, p < 0.001). Albumin 3.7 ± 0.4 vs 3.8 ± 0.3, plasma Na concentration of 137.8 ± 3.1 vs 136.1 ± 4.4. Blood pressure and pulse rate, weight gain between dialysis and hemodialysis blood pressure 140.9 ± 13.4 vs 131.8 ± 11.4, weight gain between dialysis 2.0 ± 0.8 vs 2.3 ± 0.8, systolic blood pressure after dialysis, after dialysis, diastolic Blood pressure, pulse rate before and after hemodialysis, there was no difference in thirst.
Conclusion: An individualized sodium dialysate based on predialysis plasma sodium levels decreases thirst, interdialytic weight gain, pre-HD SBP.
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