EFFECT OF DIFFERENT DIALYSATE SODIUM CONCENTRATIONS ON BLOOD PRESSURE RESPONSE DURING HEMODIALYSIS

Abstract

Objective:

The objective of this study is to observe effect of different dialysate sodium concentrations on blood pressure response during hemodialysis

Study design:

Randomized Control trial study.

Place and duration of study:

Department of Nephrology, Tertiary Care Hospital, Lahore from February 2025-April 2025.

Methodology:

105 patients undergoing hemodialysis were inducted in the study to assess the effect of different dialysate sodium concentrations on blood pressure response during maintenance hemodialysis, ESRD patients on thrice-weekly hemodialysis were enrolled. Participants underwent dialysis with sodium concentrations of 135, 138, and 142 mmol/L in randomized sequences, each for two weeks with washout periods. Blood pressure was measured pre-, intra-, and post-dialysis. The primary outcome was change in systolic blood pressure. Data were analyzed using repeated-measures ANOVA, with p < 0.05 considered significant.

Results:

A total of 105 patients (mean age 52.6 ± 13.4 years; 58.1% males) completed the study. Hypertension, diabetes, and cardiovascular disease were present in 82.9%, 46.7%, and 28.6% of participants, respectively. Lower dialysate sodium (135 mmol/L) resulted in the greatest intradialytic reductions in systolic and diastolic blood pressure and the highest rate of hypotension. Higher sodium (142 mmol/L) provided superior hemodynamic stability. The standard concentration (138 mmol/L) showed a balanced profile. Repeated-measures ANOVA demonstrated statistically significant differences across sodium levels for most primary and secondary outcomes (p < 0.001).

Conclusion:

Dialysate sodium concentration significantly affects intradialytic hemodynamic stability and interdialytic cardiovascular outcomes in maintenance hemodialysis patients. Lower sodium improves predialysis blood pressure control but increases the risk of intradialytic hypotension.