Outcome of individualized dialysate sodium concentration for hemodialysis patients

To evaluate the individualization of dialysate sodium (Na^+) concentration in hemodialysis (HD), we studied 40 stable chronic HD patients in a single-blind crossover design. They underwent 36 consecutive HD sessions with the dialysate Na^+ concentration set at 138 mmol/L,followed by 36 sessions of dialysate Na^+ set to match the patients average pre-HD plasma Na^+ levels. We multiplied the midweek pre-HD measured Na^+ by the Donnan coefficient of 0.95 (individualized Na^+). Pre-HD Na^+ dialysis sodium levels were nearly constant,with no variation between the two phases and a mean of 137.45 ± 2.04 mmol/L. Post-HD serum Na^+ was significantly higher during the standard phase (139.7 ± 2 mmol/L) than during the individualized phase (137.1 ± 1.6 mmol/L). Also,interdialytic weight gain (IDWG) was significantly more reduced during the individualized phase (3.25 ± 0.56%) than during the standard phase (3.94 ± 0.92%),P 0.001. Episodes of distressing symptoms including headache,muscle cramps and hypotension were significantly less frequent in the individualized phase. The mean of the pre-HD and post-HD systolic and diastolic blood pressures significantly decreased during the individualized phase,and we could reduce the doses of antihypertensive drugs in 10 (33.33%) patients. Individualized dialysate Na + concentration was associated with a decrease in IDWG and dialysis hypotension and related symptoms and better BP control in stable chronic HD patients.