The Impact of the Gradual Reduction of Dialysate Sodium on Occurrence of the Hypotension and Plasma Sodium Level in Hemodialysis Patients

Background: Dialysis is the most common method of caring end-stage kidney disease, but it has some complications despite its several advantages. The aim of study was to investigate the impact of the gradual reduction of dialysate sodium on occurrence of the hypotension and plasma sodium in hemodialysis patients. Methods: 56 hemodialysis patients participated in this randomized triple-blind crossover clinical trial. The patients were randomly divided into two groups of A and B. The routine method (Sodium Dialysis solution) was performed on group A, whereas the gradual reduction of sodium dialysis fluid was given to group B for three sessions. These dialysis methods were again implemented three sessions, after one week of routine dialysis (wash out). The routine method (Sodium Dialysis solution) was performed on group B, and the gradual reduction of sodium dialysis fluid was performed on group A, for three sessions. Patients' blood pressure was measured three separate times: 15 minutes before dialysis, during dialysis (first, second, third and fourth hours of dialysis) and 15 minutes after of it. Moreover, Patients' sodium level was also measured before and after the intervention. In this way, the descriptive statistics and inferential statistics (repeated measure analysis of covariance) were utilized to implement data analysis. Results: In the case of routine method, the percentages of the prevalence of hypotension in above mentioned different hours were declared 6.2%, 26.6%, 44.5%, 32.8%, respectively. On the other hand, in the case of the gradual reduction of sodium dialysis fluid, these corresponding percentages were cleared 2.3%, 1.7%, 5.31%, 44.46%, respectively. The mean differences of plasma sodium before and after dialysis in the mentioned methods were obtained as 0.58 in the case of routine method, whereas it is 2.36 in the case of gradual reduction of sodium dialysis fluid method. In this research, there was no significant difference between the rate of hypotension and plasma sodium in the gradual reduction of sodium dialysis fluid by the routine method under 80% powers. Conclusions: The experimental results revealed that a gradual reduction of the sodium dialysis fluid did not play a significant role in the reduction of blood pressure during dialysis and plasma sodium in hemodialysis patients. However, either confirmation or rejection of this issue will require further studies and resolving the limitations.