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  • Title: Audit of the effect of dialysate sodium concentration on inter-dialytic weight gains and blood pressure control in chronic haemodialysis patients.
    Author: Davenport A.
    Journal: Nephron Clin Pract; 2006; 104(3):c120-5. PubMed ID: 16837813.
    Abstract:
    BACKGROUND/AIMS: Over the last three decades the standard dialysate sodium concentration has increased from 136 to 140 mmol/l (mEq/l) today. There has been great debate as to whether a reduction in dialysate sodium alone can lead to improved blood pressure control, and reduced inter-dialytic weight gain. METHODS: An audit was performed in 469 maintenance regular haemodialysis patients who dialysed in seven different centres under the care of one university medical school. RESULTS: Those centres which predominantly used a dialysate sodium of 140 mmol/l (mEq/l) had increased inter-dialytic weight gains, with more difficult blood pressure control, as not only did a greater percentage of patients require anti-hypertensive medication, but also more were prescribed multiple classes of anti-hypertensive agents. There was no difference in the frequency of symptomatic intra-dialytic hypotension. CONCLUSIONS: A reduction in dialysate sodium was associated with lower inter-dialytic weight gains, without any additional intra-dialytic hypotensive episodes. Those patients in whom the difference between the time-averaged dialysate sodium concentration and the midweek pre-dialysis serum sodium was positive result had increased inter-dialytic weight gains, compared to those with a negative value. Reduced dialysate sodium alone was not effective in controlling blood pressure without additional proper dietary sodium restriction.
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