Plasma sodium (CpNa) "setpoint": Relationship to interdialytic weight gain (IWG) and mean arterial pressure (MAP) in hemodialysis patients (HDP).
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:241A 1997
We tend to use a higher dialysate sodium to limit the occurrence of cramps and also to increase tolerance to fluid removal. The price we pay is increased post-dialysis thirst and higher interdialytic weight gains. Most units take a "one size fits all" approach to dialysate sodium; some use 135 mM for all patients, others 140, still others 142 or 145. At last year's ASN, Donohoe et al. suggested that use of a lower sodium bath, however, reduces the prevalence of hypertension.
In this very interesting and important abstract, Keen, Janson and Gotch find that patients are all different, and each tends to have an individual " set point" for sodium. A given patient will adjust water intake during the interdialytic interval until that set point is reached, and will, over time, reliably maintain a particular set serum Na level that ranged from 132 to 142 mm. The investigators made these conclusions based on study of repeated predialysis serum Na measurements in 58 patients.
Comment: The implications of this study in terms of salt and water management are potentially large. Of course salt restriction remains primary in all such patients. However, one might easily envision an approach that uses a higher dialysate sodium level routinely for patients with higher predialysis serum Na setpoints, and that also allows judicious use of low sodium dialysate for patients with low set-points. The observation opens up the field for a series of meaningful studies. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Complications (acute)
CRF by organ system : Cardiovascular/Hypertension