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The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload.
Emilie Trinh1, Catherine Weber1
1Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada.
Nephron Extra
|April 18, 2017
Summary
Higher dialysate-to-serum sodium gradient in hemodialysis is linked to increased fluid overload, specifically greater interdialytic weight gain and ultrafiltration rates. This suggests individualizing dialysate sodium may reduce fluid overload complications.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Research
Background:
- Fluid overload is a common and serious complication in conventional hemodialysis patients.
- It is associated with increased cardiovascular morbidity and mortality.
- Dialysate sodium prescription is a modifiable factor influencing fluid status.
Purpose of the Study:
- To describe associations between the dialysate-to-serum sodium gradient and fluid status parameters.
- To evaluate the 6-month risk of hospitalization and mortality related to the sodium gradient.
Main Methods:
- A cross-sectional study involving 110 prevalent conventional hemodialysis patients.
- Analysis of associations between sodium gradient and interdialytic weight gain index (IDWG%), ultrafiltration (UF) rate, and blood pressure (BP).
Main Results:
- A direct correlation was observed between sodium gradient and both IDWG% (r=0.48) and UF rate (r=0.44).
- A higher sodium gradient was associated with an increased risk of excessive IDWG% and UF rate.
- No significant associations were found with intradialytic hypotension, hypertension, blood pressure, hospitalization, or mortality.
Conclusions:
- Increased dialysate-to-serum sodium gradient correlates with greater fluid overload (IDWG and UF rates).
- Individualizing dialysate sodium prescription to minimize the sodium gradient may help reduce fluid overload in hemodialysis patients.