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The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The

Jochen G Raimann1, Christopher T Chan2, John T Daugirdas3

  • 1Renal Research Institute, New York, New York, USA.

Kidney & Blood Pressure Research
|October 13, 2021
PubMed

Insights

Frequent hemodialysis significantly reduced left-ventricular mass in patients with lower predialysis serum sodium. Higher dialysate-to-predialysis sodium gradient and fluid load also amplified these benefits, suggesting personalized treatment approaches.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • The Frequent Hemodialysis Network (FHN) trials previously established that hemodialysis (HD) administered 6 times weekly, compared to 3 times weekly, significantly reduces left-ventricular mass (LVM).
  • The impact of predialysis serum sodium (SNa) and related plasma tonicity markers on the efficacy of frequent HD was not fully understood.
  • This study investigates SNa and other factors as potential modifiers of frequent HD's effect on LVM.

Purpose of the Study:

  • To examine whether predialysis serum sodium (SNa) and related parameters modify the effect of frequent hemodialysis (HD) on left-ventricular mass (LVM).
  • To explore the influence of dialysate-to-predialysis serum-sodium gradient (GNa), fluid load (TIFL), and extracellular fluid volume on frequent HD outcomes.

Main Methods:

  • Analysis of data from the FHN Daily and Nocturnal Trials.
  • Stratification of patients based on predialysis serum sodium (SNa), dialysate-to-predialysis serum-sodium gradient (GNa), blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume.
  • Comparison of frequent HD's effect on LVM across these patient strata.

Main Results:

  • In the FHN Daily Trial, frequent HD significantly reduced LVM, with a greater reduction observed in patients with lower predialysis SNa (<138 mEq/L) compared to those with higher SNa.
  • The beneficial effect of frequent HD on LVM was more pronounced in patients with higher dialysate-to-predialysis serum-sodium gradient (GNa) and higher time-integrated sodium-adjusted fluid load (TIFL).
  • Similar trends were observed in the FHN Nocturnal Trial, but they did not reach statistical significance.

Conclusions:

  • Lower predialysis serum sodium and higher GNa and TIFL identify patients who experience greater benefits from frequent HD regarding left-ventricular hypertrophy in the FHN Daily Trial.
  • These findings suggest that SNa, GNa, and TIFL may help personalize frequent HD treatment strategies.
  • Further research is needed to confirm these metrics for patient selection and to investigate the impact of GNa reduction on clinical outcomes like mortality and hospitalization.
Abstract

Keywords:
Blood pressureEffect modificationFluid overloadFrequent hemodialysisLeft-ventricular mass

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