Colson Arthur, Brinkley Anita, Braconnier Philippe, Ammor Nadia, Burnier Michel, Pruijm Menno
Faculty of Medicine, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
Service of Nephrology and Hypertension, University Hospital of Lausanne, Lausanne, Switzerland.
Hemodial Int. 2018 Oct;22(4):501-506. doi: 10.1111/hdi.12655. Epub 2018 Apr 6.
Patients on hemodialysis (HD) are advised to limit daily water- and salt intake to reduce interdialytic weight gain (IDWG). To counterbalance protein-losses, protein-rich meals are sometimes provided during HD sessions, but their salt content is not always taken into account. The aim of this study was to assess the influence of a lower salt content of meals provided during HD sessions on IDWG, blood pressure (BP), and hemodynamic stability during dialysis.
This monocentric, interventional study was proposed to all the patients treated with three weekly HD sessions. The first two months of the study (high salt period), the patients continued to receive one sandwich containing 2.4 g of salt per session. Then, we reduced its salt content from 2.4 to 1.4 g, and patients received this "low-salt sandwich" at each dialysis session for four months. The mean values of IDWG, BP, and dry weight of the first two months were compared with those collected during the low salt periods (2-6 months).
Forty out of 76 patients who initially agreed to participate were free of hospitalization, transplantation, and transfer to another center or death during the study period and were included in the final analysis (35% women). Median age was 63 years (range 28-90), 22.5% had a residual diuresis > 0.5 L/day. IDWG baseline decreased from 2.17 ± 0.98 to 2.03 ± 1 kg (P = 0.001) two months and to 2.09 ± 1.01 kg (P = 0.009) four months after we had lowered the salt content of the sandwich. The number of symptomatic intradialytic hypotension was also reduced (6.1% vs., respectively, 3.2% and 3.3% of HD sessions; P = 0.004).
IDWG was reduced and hemodynamic stability improved after the reduction of the salt content of perdialytic meals. This suggests that salt consumed during HD matters and might influence salt and water intake outside the dialysis unit.
建议接受血液透析（HD）的患者限制每日水和盐的摄入量，以减少透析间期体重增加（IDWG）。为了平衡蛋白质流失，有时会在血液透析期间提供富含蛋白质的餐食，但餐食中的盐含量并未总是被考虑在内。本研究的目的是评估血液透析期间提供的餐食较低盐含量对IDWG、血压（BP）和透析期间血液动力学稳定性的影响。
本单中心干预性研究针对所有接受每周三次血液透析治疗的患者。研究的前两个月（高盐期），患者每次继续接受一个含盐2.4克的三明治。然后，我们将其盐含量从2.4克降至1.4克，患者在每次透析期间接受这种“低盐三明治”，持续四个月。将前两个月的IDWG、BP和干体重的平均值与低盐期（第2至6个月）收集的值进行比较。
最初同意参与的76名患者中，有40名在研究期间未住院、未接受移植、未转至另一中心或死亡，并被纳入最终分析（35%为女性）。中位年龄为63岁（范围28 - 90岁），22.5%的患者残余尿量>0.5升/天。在我们降低三明治盐含量两个月后，IDWG基线从2.17±0.98降至2.03±1千克（P = 0.001），四个月后降至2.09±1.01千克（P = 0.009）。有症状的透析中低血压的次数也减少了（分别为血液透析次数的6.1%、3.2%和3.3%；P = 0.004）。
透析期间餐食盐含量降低后，IDWG减少，血液动力学稳定性得到改善。这表明血液透析期间摄入的盐很重要，可能会影响透析单元外的盐和水的摄入量。
