Low dialysate sodium and 48-h ambulatory blood pressure in patients with intradialytic hypertension: a randomized crossover study

Fotini Iatridi; Konstantinos Malandris; Robert Ekart; Efstathios Xagas; Antonios Karpetas; Marieta P Theodorakopoulou; Artemios Karagiannidis; Areti Georgiou; Aikaterini Papagianni; Pantelis Sarafidis

doi:10.1093/ndt/gfae104

Low dialysate sodium and 48-h ambulatory blood pressure in patients with intradialytic hypertension: a randomized crossover study

Nephrol Dial Transplant. 2024 May 6:gfae104. doi: 10.1093/ndt/gfae104. Online ahead of print.

Affiliations

¹ First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece.
² Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ Department of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia.
⁴ Frontis Dialysis Center, Athens, Greece.
⁵ Therapeutiki Hemodialysis Unit, Thessaloniki, Greece.

PMID: 38710537
DOI: 10.1093/ndt/gfae104

Abstract

Background and hypothesis: Intradialytic-hypertension (IDH) is associated with increased risk for cardiovascular events and mortality. Patients with IDH exhibit higher 48-h blood pressure (BP) levels than patients without this condition. Volume and sodium excess are considered a major factor contributing in the development of this phenomenon. This study evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on 48-h BP in patients with IDH.

Methods: In this randomized, single-blind, crossover study, 29 patients with IDH underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice-versa. Mean 48-h BP, pre-/post-dialysis and intradialytic BP, pre-dialysis weight, interdialytic weight gain (IDWG) and lung ultrasound B-lines were assessed.

Results: Mean 48-h SBP/DBP were significantly lower with low compared to standard dialysate sodium concentration (137.6±17.0/81.4±13.7mmHg with low vs 142.9±14.5/84.0±13.9mmHg with standard dialysate sodium, p=0.005/p=0.007 respectively); SBP/DBP levels were also significantly lower during the 44-h and different 24-h periods. Low dialysate sodium significantly reduced post-dialysis (SBP/DBP: 150.3±22.3/91.2±15.1mmHg with low vs 166.6±17.3/94.5±14.9mmHg with standard dialysate sodium, p<0.001/p=0.134 respectively) and intradialytic (141.4±18.0/85.0±13.4mmHg with low vs 147.5±13.6/88.1±12.5mmHg with standard dialysate sodium, p=0.034/p=0.013, respectively) BP compared with standard dialysate sodium. Pre-dialysis weight, IDWG and pre-dialysis B-lines were also significantly decreased with low dialysate sodium.

Conclusions: Low dialysate sodium concentration significantly reduced 48-h ambulatory BP compared with standard dialysate sodium in patients with IDH. These findings support low dialysate sodium as a major non-pharmacologic approach for BP management in patients with IDH.Registered at ClinicalTrials.gov with study number NCT05430438.

Keywords: ABPM; blood pressure; dialysate sodium; hemodialysis; intradialytic hypertension (IDH).

Associated data

ClinicalTrials.gov/NCT05430438