Sodium profiling: the key to reducing symptoms of dialysis?

A systematic review was undertaken in order to critically appraise the current knowledge base of sodium profiling in hemodialysis. Between 15%-80% of patients on hemodialysis experience symptoms of dialysis intolerance every dialysis session. The purpose of this review was to identify whether sodium profiling is an effective intervention in removing or reducing these untoward effects.

A literature search was undertaken using Medline and Embase. Inclusion criteria were primary research or controlled clinical trials published between January 1990 and June 2006 and studies in the chronic dialysis setting and studies that identified sodium profiling as the intervention in hemodialysis or hemodiafiltration. Articles excluded included: those that could not establish whether sodium profiling was the intervention responsible for the outcome; articles on hemofiltration; and review articles and research pertaining to the acute setting. Thirteen articles met the inclusion criteria and were included in the final review.

A number of flaws were identified with methodological adequacy and consistency of findings. It was not possible to determine whether positive effects outweighed negative effects in this review. In the majority of studies, there was a lack offollow-up and the inability to determine long-term outcomes of patients who received sodium profiling.

This evaluative review could not provide evidence to support the clinical use of sodium profiling in the population of patients on hemodialysis who are symptomatic. There remains a theoretical base for the use of sodium profiling, however further studies are needed providing consistency in methodology, looking not only at reduction in morbidity but effects on quality of life, long-term outcomes, and mortality.