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  • Title: Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis.
    Author: Thomson BK, Huang SH, Leitch RE, Dixon S, Heidenheim P, Suri RS, Chan CT, Lindsay RM.
    Journal: Hemodial Int; 2013 Oct; 17(4):548-56. PubMed ID: 23551488.
    Abstract:
    Sodium balance across a hemodialysis treatment influences interdialytic weight gain (IDWG), pre-dialysis blood pressure, and the occurrence of intradialytic hypotension, which associate with patient morbidity and mortality. In thrice weekly conventional hemodialysis patients, the dialysate sodium minus pre-dialysis plasma sodium concentration (δDPNa+) and the post-dialysis minus pre-dialysis plasma sodium (δPNa+) are surrogates of sodium balance, and are associated with both cardiovascular and all-cause mortality. However, whether δDPNa+ or δPNa+ better predicts clinical outcomes in quotidian dialysis is unknown. We performed a retrospective analysis of clinical and demographic data from the Southwestern Ontario Regional Home Hemodialysis program, of all patients since 1985. In frequent nocturnal hemodialysis, δPNa+ was superior to δDPNa+ in predicting IDWG (R(2)=0.223 vs. 0.020, P=0.002 vs. 0.76), intradialytic change in systolic (R(2)=0.100 vs. 0.002, P=0.02 vs. 0.16) and diastolic (R(2)=0.066 vs. 0.019, P=0.02 vs. 0.06) blood pressure, and ultrafiltration rate (R(2)=0.296 vs. 0.036, P=0.001 vs. 0.52). In short hours daily hemodialysis, δDPNa+ was better than δPNa+ in predicting intradialytic change in diastolic blood pressure (R(2)=0.101 vs. 0.003, P=0.02 vs. 0.13). However, δPNa+ was better than δDPNa+ in predicting IDWG (R(2)=0.105 vs. 0.019, P=0.04 vs. 0.68) and pre-dialysis systolic blood pressure (R(2)=0.103 vs. 0.007, P=0.02 vs. 0.82). We also found that the intradialytic blood pressure fall was greater in frequent nocturnal hemodialysis patients than in short hours daily patients, when exposed to a dialysate to plasma sodium gradient. These results provide a basis for design of prospective trials in quotidian dialysis modalities, to determine the effect of sodium balance on cardiovascular outcome.
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