Maya N. Clark-Cutaia, PhD, ACNP-BC, RN, is Assistant Professor, Rory Meyers College of Nursing, New York University, New York. She was Lecturer in the Biobehevioral Health Sciences Department, the University of Pennsylvania, Philadelphia, when the research was completed. Nathaniel Reisinger, MD, is Nephrology Fellow, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and Hypertension Program, the Hospital of the University of Pennsylvania, Philadelphia. Maria Rita Anache, BS, is Research Assistant, School of Osteopathic Medicine, Rowan University, Stratford, New Jersey. Kara Ramos, BSN, is Research Assistant, School of Nursing, University of Pennsylvania, Philadelphia. Marilyn S. Sommers, PhD, RN, FAAN, is Professor Emerita, School of Nursing, University of Pennsylvania, Philadelphia. She was the Lillian S. Brunner Professor of Medical-Surgical Nursing during the time that the work for this study was completed. Raymond R. Townsend, MD, is Professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and Director, Hypertension Program, the Hospital the University of Pennsylvania, Philadelphia. Gary Yu, DrPH, MPH, is Associate Research Scientist, Rory Meyers College of Nursing, New York University, New York. Jamison Fargo, PhD, MS-EPI, is Professor, Utah State University, Logan.
Nurs Res. 2019 May/Jun;68(3):246-252. doi: 10.1097/NNR.0000000000000320.
Cardiovascular disease accounts for more than half of all deaths in the hemodialysis (HD) population. Although much of this mortality is associated with fluid overload (FO), FO is difficult to measure, and many HD patients have significant pulmonary congestion despite the absence of clinical presentation. Cohort studies have observed that FO, as measured by bioimpedance spectroscopy (BIS), correlates with mortality. Other studies have observed that lower sodium intake is associated with less fluid-related weight gain, improved hypertension, and survival. Whether sodium intake influences FO in HD patients as measured by BIS is not known.
The aims of the study were to determine the feasibility of assessing the impact of sodium restriction on body fluid composition as measured by BIS among patients with three levels of sodium intake and to determine if there are statistical and/or clinical differences in BIS measures across sodium intake groups.
We used a double-blinded randomized controlled trial design with three levels of sodium restriction, 2,400 mg per day, 1,500 mg per day, and unrestricted (control group), to test our aims. Forty-two HD patients from a tertiary acute care academic institution associated with three urban DaVita dialysis centers were enrolled. Participants remained in the inpatient center for 5 days and 4 nights and were randomly assigned to sodium intake groups. Body fluid composition was measured with BIS.
Recruitment, enrollment, and retention statistics supported the feasibility of the study design. Regression analyses showed that there were no statistically significant differences among sodium intake groups on any of the outcomes.
Our data suggest the need for additional research into the effects of sodium restriction on body fluid composition.
心血管疾病占血液透析（HD）人群死亡人数的一半以上。尽管大部分死亡与液体超负荷（FO）有关，但 FO 难以测量，许多 HD 患者尽管没有临床表现，但仍存在明显的肺充血。队列研究观察到，生物电阻抗谱（BIS）测量的 FO 与死亡率相关。其他研究观察到，钠摄入量较低与较少的与液体相关的体重增加、改善的高血压和生存有关。钠摄入量是否会影响 BIS 测量的 HD 患者的 FO 尚不清楚。
本研究的目的是确定评估三种钠摄入量水平的患者中钠限制对 BIS 测量的体液成分影响的可行性，并确定 BIS 测量值在钠摄入组之间是否存在统计学和/或临床差异。
我们使用了一项双盲随机对照试验设计，有三种钠限制水平，即每天 2400 毫克、每天 1500 毫克和无限制（对照组），以检验我们的目的。来自一家与三个城市 DaVita 透析中心相关的三级急性护理学术机构的 42 名 HD 患者被纳入研究。参与者在住院中心停留了 5 天 4 夜，并被随机分配到钠摄入组。使用 BIS 测量体液成分。
招募、入组和保留统计数据支持研究设计的可行性。回归分析显示，钠摄入组在任何结果上均无统计学差异。
我们的数据表明，需要进一步研究钠限制对体液成分的影响。
