Table 2.
Selected studies supporting the use of lower dialysate sodium.
| Author (Year) DNa Comparison | Patient and HD treatment characteristics | Study design | Outcome | Comments | ||
|---|---|---|---|---|---|---|
| Pre-HD BP | IDWG | IDH and symptoms | ||||
| All Patients | ||||||
|
Sadowski (1993)47 3 different modeling strategies of 148→138 vs. fixed 138 mEq/L |
N=16 (2 wks/arm) -Prevalent -Median age 19y |
Randomized cross-over (4 arms) | NS | ↑ IDWG with higher DNa | ↓ post-HD hypotension with higher DNa | -Small N -Younger, non-diabetic patients |
|
Thein (2007)50 141 vs. 138 mEq/L |
N=58 -Incident and prevalent -Mean age 52y |
Non-randomized facility level change in DNa (compared 4m pre- and 4m post-facility change) | ↓ BP with lower DNa | NS | NS | -10 patients dropped out during study period -Lack of detail on intra-dialytic symptoms and BP measurements -Non-randomized |
|
Davenport (2008)52 >140 vs. 140 vs. <140 mEq/L |
N=2,187 -Prevalent -Median age 61y |
Cross-sectional audit | ↑ BP with higher DNa | ↑ IDWG with higher DNa | ↑ IDH with higher DNa | -Cross-sectional -Potential confounding by indication for prescription of higher Dialysate sodium for hypotension-prone patients |
|
Kutlugün (2011)49 143 vs. 137 mEq/L |
N=30 (6 wks/arm) -Five patients on twice weekly HD -Prevalent -Mean age 48y |
Non-randomized cross-over (2 arms) | ↑ BP with higher DNa | ↑ IDWG with higher DNa | ↓ symptoms with higher DNa | -Small N -Inclusion of twice-weekly HD -Exclusion of hypotension-prone patients -Two patients withdrew due to symptoms on low DNa arm -Non-randomized |
| Hypotension Prone Patients | ||||||
|
Song (2002)43 Combinations of fixed and modeled DNa with UF profiles vs. constant DNa 138 mEq/L |
N=11 (264 tmts; 33 sessions per arm) -Prevalent -Mean age 54y |
Randomized cross-over (8 arms) | NS | ↑ IDWG with sodium modeling | ↓ treatment failures with sodium modelinga | -Small N -Complex protocol -Multiple comparisons |
a
Treatment failure defined as at least 1 of the following: HD treatment stopped before 75% of prescribed time completed; % ultrafiltration achieved <70%; Kt/V <1.1.
Abbreviations: Dialysate sodium, dialysate sodium; BP, blood pressure; IDH, intradialytic hypotension; NS, non-significant difference; NR, not reported; HD, hemodialysis.