Effi cacy of stepwise sodium profi le versus individualized dialysate sodium in blood pressure control among hemodialysis patients

Abstract

ABSTRACT

Background: Hypertension is very common in patients with end-stage renal disease and accelerates cardiovascular morbidity and mortality. The most important factor in achieving normal blood pressure in these patients is reaching dry weight. Sodium and extracellular fl uid balance play a vital role in this regard. Considering the lack of consensus about the effi cacy of stepwise sodium profi le and individualized dialysate sodium, this study aimed to determine the superior method for blood pressure control in hemodialysis patients.

Materials and Methods: In a quasi-experimental study, patients satisfying the inclusion criteria were enrolled through convenience sampling. The patients were randomly assigned to two groups of stepwise sodium profi le and individualized dialysate sodium. Information record form was used for data collection. Data were analyzed with paired and independent t-test and descriptive statistics using SPSS for Windows 20.0.

Results: Patients in the two groups were similar in qualitative and quantitative background variables. While systolic blood pressure signifi cantly decreased following hemodialysis with individualized dialysate sodium (P < 0.001), there was no signifi cant difference between pre- and post-dialysis systolic blood pressure values using stepwise sodium profi le (P = 0.060). Individualized dialysate sodium caused greater change in the mean systolic blood pressure than stepwise sodium profi le did (P = 0.040). Pre- and post-dialysis diastolic blood pressure values showed signifi cant differences in both groups (P < 0.001 using individualized dialysate sodium and P = 0.009 using stepwise sodium profi le). However, the mean changes in diastolic blood pressure of the two groups were not signifi cantly different (P = 0.295).

Conclusions: We found no signifi cant difference in interdialytic weight gain and blood pressure control by the two methods. The change in systolic blood pressure was lower in the stepwise profi le method than in the individualized dialysate sodium method, and this method did not cause interdialytic hypertension. So, by adjusting the dialysis solution with regard to plasma sodium levels, lead to more blood pressure control. Meanwhile, the two groups were not signifi cantly different in the mean changes of diastolic blood pressure.

Key words: Dialysate, hemodialysis, hypertension, interdialytic weight gain 1Department of