The Effect of High Sodium Dialysate(HSD) on Blood Pressure in Hemodilaysis

Song, Ho Cheol; Choi, Euy Jin; Hun, Lee Dae; Park, Soon Min; Kim, Yeon Sik; Jang, Seong Won; Yoon, Sung No; Yoon, Sun Ae; Ahn, Seog Ju; Bang, Byung Kee

Abstract

Hypotensive episode is one of the serious complication during hemodialysis. HSD has used for relief of this problem, but sometimes increased interdialytic weight gain or exacerbation of hypotension are happened. To evaluate the effect of HSD, 7 non- diabetic normotensive uremic patients were hemodialyzed with different sodium level of dialysate (stage A : Na 138mEq/L for 4hrs, stage B : Na 148mEq/L for 4hrs, stage C : initially Na 148mEq/L for 3hrs and Na 138mEq/L for 1hrs), and each stages were continued for 2 weeks. Ultrafiltration was performed to maintain the patient's estimated dry weight constantly. Interdialytic weight gain(stage A : 2.9+/-1.2kg, stage B : 3.2+/-1.1kg, stage C : 3.1+/-0.8kg) and presystolic systolic and diastolic blood pressure were not different in each stage. The incidence of hypotension (systolic BP<90mmHg) during hemodialysis was significantly lower in stage B and stage C(24%, 21%) than stage A(54%)(P<0.01). During hemodialysis the incidence of thirst was higher in stage B(40%) than stage A and stage C(11%, 12%) (P<0.05) significantly but there are no difference in headache and itching during hemodialysis between the each stage. Pre-dialysis and post-dialysis serum sodium and osmolality were not different in each stage but at 2 hrs after initiation of hemodialysis serum sodium and osmolality were higher in stage B(145.6+/-2.1mEq/L, 306+/-6.7mOsm/kg) and stage C (146.1+/-2.1mEq/L, 306+/-13.1mOsm/kg) than stage A (140.1+/-2.5mEq/L, 292+/-8.7mOsm/kg)(P<0.05). The ANP levels of pre-dialysis and post-dialysis were not different in each stage. In conclusion, HSD improved hypotenive episode. In spite of sodium load, increased interdialytic weight gain and elevation of pre-dialysis blood pressure were not developed and sodium modeling during hemodialysis attenuate some adverse effect of HSD.