de Paula Flavio M, Peixoto Aldo J, Pinto Luciano V, Dorigo David, Patricio Pedro J M, Santos Sergio F F
Division of Nephrology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Kidney Int. 2004 Sep;66(3):1232-8. doi: 10.1111/j.1523-1755.2004.00876.x.
Predialysis plasma sodium (Na(+)) concentration is relatively constant in hemodialysis (HD) patients, and a higher dialysate Na(+) concentration can promote an increase in the interdialytic fluid ingestion to achieve an individual's osmolar set point, and individualization of dialysate Na(+) concentration may improve interdialytic weight gain (IDWG), blood pressure (BP), and HD-related symptoms.
Twenty-seven nondiabetic, non-hypotension prone HD patients were enrolled in a single-blind crossover study. Subjects underwent nine consecutive HD sessions with the dialysate Na(+) concentration set to 138 mEq/L (standard Na(+) HD), followed by nine sessions wherein the dialysate Na(+) was set to match the patients average pre-HD plasma Na(+) measured three times during the standard Na(+) phase multiplied by 0.95 (individualized dialysate Na(+) HD). Dry weight, dialysis prescription, and medications were not modified during the six weeks of the study.
Pre-HD Na(+) was similar in both periods of the study (standard Na(+) HD, 134.0 +/- 1.4 mEq/L; individualized Na(+) HD, 134.0 +/- 1.5 mEq/L; P= 0.735). There was a significant decrease in interdialytic weight gain (2.91 +/- 0.87 kg vs. 2.29 +/- 0.65 kg; P< 0.001), interdialytic thirst scores, and episodes of intradialytic hypotension in the individualized Na(+) period compared with the standard phase. Pre-HD BP was lower in individualized Na(+) HD in patients with uncontrolled BP at baseline (N= 15), but not in those with controlled BP at baseline (N= 12) (DeltaBP -15.6/-6.5 mm Hg in uncontrolled vs. DeltaBP +6.4/+4.5 mm Hg in controlled, P= <0.001 for systolic BP and P= <0.001 for diastolic BP).
An individualized Na(+) dialysate based on predialysis plasma Na(+) levels decreases thirst, IDWG, HD-related symptoms, and pre-HD BP (in patients with uncontrolled BP at baseline).
血液透析（HD）患者透析前血浆钠（Na⁺）浓度相对恒定，较高的透析液钠浓度可促进透析间期液体摄入量增加，以达到个体的渗透压设定点，透析液钠浓度个体化可能改善透析间期体重增加（IDWG）、血压（BP）及与HD相关的症状。
27例非糖尿病、不易发生低血压的HD患者纳入一项单盲交叉研究。受试者连续进行9次HD治疗，透析液钠浓度设定为138 mEq/L（标准钠HD），随后进行9次治疗，其中透析液钠设定为匹配患者在标准钠阶段三次测量的平均透析前血浆钠乘以0.95（个体化透析液钠HD）。在研究的六周内，干体重、透析处方和药物未作调整。
研究的两个阶段透析前钠浓度相似（标准钠HD，134.0±1.4 mEq/L；个体化钠HD，134.0±1.5 mEq/L；P = 0.735）。与标准阶段相比，个体化钠阶段透析间期体重增加显著减少（2.91±0.87 kg对2.29±0.65 kg；P < 0.001），透析间期口渴评分及透析中低血压发作次数减少。基线时血压未控制的患者（N = 15）在个体化钠HD时透析前血压较低，但基线时血压控制良好的患者（N = 12）并非如此（收缩压在未控制组中变化为-15.6/-6.5 mmHg，在控制组中变化为+6.4/+4.5 mmHg，P收缩压< 0.001，P舒张压< 0.001）。
基于透析前血浆钠水平的个体化钠透析液可减少口渴、IDWG、与HD相关的症状以及透析前血压（基线时血压未控制的患者）。
