A SECOND LOOK ON DIALYSIS PRACTICES: THE EFFECTS OF LOWER SODIUM DIALYSATE ON BLOOD PRESSURE IN INTRADIALYTIC HYPERTENSION PATIENTS IN INDIA

Abstract

Background: Introduction intradialytic hypertention (IDHTN) is a crital complication in patients on hemodialysis and is a we-establition cardiovascular morbidity and mortality event. Dialsate sodium concertation is a crucial determinant of blood pressure, but the optimal dialysate sodium concertation in the prevention of IDHTN continues to be known.

Aim: This study assesses the differences with respect to the pattern of ambulator blood pressure (ABP) in patients with isometric dialysate HTN (IDHTN) when dialysate sodium concertration is reduced.

Methodology: This was an 18-month prospective observational study done at a tertiary care hospital in Chennai enrolling 47 hemodialysis patients with IDHTN. There were two phases of dialysis (Phase 1 140 mEq/L dialysate sodium; Phase 2 138 mEq/L); ABP was measured over 24 hours during the interdialytic period following each phase. Results: With 138 mEq/L dialysate, there was a significant decrease in systolic blood pressure (SBP) from 148.85 ± 11.67 mmHg at hour two to 142.60 ± 12.88 mmHg at the end of dialysis (p < 0.05). There were also reductions in diastolic blood pressure (DBP)but these did not achieve statistical significance. Phase 2 also evidenced lower mean SBP and DBP in a 24-hour ABP analysis. Hypotensive events remained the same, but muscle cramps and shivering events were less frequent.

Conclusion: In patients with IDHTN, dropping dialysate sodium to 138 mEq/L persistently reduces blood pressure and the potential for non-drug intervention like this is now high. Nonetheless, there is a prospect of hypotension if the sodium has not

been closely monitored, and so individual sodium profiling is key.