alexa Effect of Personalized Dialysate Sodium Prescription on
ISSN: 2161-0959

Journal of Nephrology & Therapeutics
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Research Article

Effect of Personalized Dialysate Sodium Prescription on Plasma Sodium Concentration and Sodium Set Point in Conventional, Quotidian and Nocturnal Home Hemodialysis

Benjamin Thomson1,2*, Lihua Li3 and Robert Lindsay2,3,4

1Division of Nephrology, Kingston General Hospital, Kingston, Ontario, Canada

2Department of Medical Biophysics, Western University, London, Ontario, Canada

3Kidney Clinical Research Unit, London Health Sciences Centre and Western University, London, Ontario, Canada

4Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada

*Corresponding Author:
Benjamin Thomson
76 Stuart Street, Burr 3-38
Queen’s University
Kingston Ontario K7L-2V7, Canada
Tel: (613) 549-6666 X7306
E-mail: [email protected]

Received Date: June 14, 2017; Accepted Date: June 19, 2017; Published Date: June 26, 2017

Citation: Thomson B, Li L, Lindsay R (2017) Effect of Personalized Dialysate Sodium Prescription on Plasma Sodium Concentration and Sodium Set Point in Conventional, Quotidian and Nocturnal Home Hemodialysis. J Nephrol Ther 7: 294. doi:10.4172/2161-0959.1000294

Copyright: © 2017 Thomson B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

Introduction and objectives: In thrice weekly conventional hemodialysis, dialysate sodium prescription can cause intradialytic plasma sodium shifts, and undesirable symptoms. However, changes in pre-dialysis plasma sodium setpoint are not observed. Whether these clinical observations are observed in quotidian or nocturnal home hemodialysis has not been prospectively evaluated. Methods: A randomized crossover study of conventional, quotidian and nocturnal home hemodialysis patients was performed. Dialysate sodium was personalized 3 mmol/L above (HIGHDIALSOD) or below (LOWDialSOD) the SP, with 100 days for each crossover studies period. Results: Plasma Na+ decreased during hemodialysis in LOWDialSOD study period (136.8 to 135.0 mmol/L, p=0.002). Pre-Na+ SP (137.4 to 136.8 mmol/L, p=0.03) and Pre-Na+ SP slope (0.014 to -0.015 mmol/L/day, p=0.009) decreased from HIGHDialSOD to LOWDialSOD study periods. Conclusions: Personalization of Dial-Na+ to below SP leads to reductions in plasma sodium concentration during hemodialysis, in conventional, quotidian and nocturnal home hemodialysis patients. Furthermore, sodium set point changes in response to Dial-Na+ prescription. This has the potential to lead to adverse outcomes in a patient population that is followed less frequently and stringently than the in-center hemodialysis population.

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