First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Nephrol Dial Transplant. 2024 Oct 30;39(11):1900-1910. doi: 10.1093/ndt/gfae104.
Intradialytic hypertension (IDH) is associated with increased risk for cardiovascular events and mortality. Patients with IDH exhibit higher 48-h blood pressure (BP) levels than patients without this condition. Volume and sodium excess are considered a major factor contributing in the development of this phenomenon. This study evaluated the effect of low (137 mEq/L) compared with standard (140 mEq/L) dialysate sodium concentration on 48-h BP in patients with IDH.
In this randomized, single-blind, crossover study, 29 patients with IDH underwent four hemodialysis sessions with low (137 mEq/L) followed by four sessions with standard (140 mEq/L) dialysate sodium, or vice versa. Mean 48-h BP, pre-/post-dialysis and intradialytic BP, pre-dialysis weight, interdialytic weight gain (IDWG) and lung ultrasound B-lines were assessed.
Mean 48-h systolic/diastolic BP (SBP/DBP) were significantly lower with low compared with standard dialysate sodium concentration (137.6 ± 17.0/81.4 ± 13.7 mmHg with low vs 142.9 ± 14.5/84.0 ± 13.9 mmHg with standard dialysate sodium, P = .005/P = .007, respectively); SBP/DBP levels were also significantly lower during the 44-h and different 24-h periods. Low dialysate sodium significantly reduced post-dialysis (SBP/DBP: 150.3 ± 22.3/91.2 ± 15.1 mmHg with low vs 166.6 ± 17.3/94.5 ± 14.9 mmHg with standard dialysate sodium, P < .001/P = .134, respectively) and intradialytic (141.4 ± 18.0/85.0 ± 13.4 mmHg with low vs 147.5 ± 13.6/88.1 ± 12.5 mmHg with standard dialysate sodium, P = .034/P = .013, respectively) BP compared with standard dialysate sodium. Pre-dialysis weight, IDWG and pre-dialysis B lines were also significantly decreased with low dialysate sodium.
Low dialysate sodium concentration significantly reduced 48-h ambulatory BP compared with standard dialysate sodium in patients with IDH. These findings support low dialysate sodium as a major non-pharmacologic approach for BP management in patients with IDH.
ClinicalTrials.gov study number NCT05430438.
透析中高血压（IDH）与心血管事件和死亡率风险增加相关。IDH 患者的 48 小时血压（BP）水平高于无此情况的患者。容量和钠过量被认为是导致这种现象的主要因素。本研究评估了低（137 mEq/L）与标准（140 mEq/L）透析液钠浓度对 IDH 患者 48 小时 BP 的影响。
在这项随机、单盲、交叉研究中，29 名 IDH 患者接受了 4 次低（137 mEq/L）透析液和 4 次标准（140 mEq/L）透析液治疗，或反之亦然。评估了 48 小时平均 BP、透析前/后和透析中 BP、透析前体重、透析间体重增加（IDWG）和肺部超声 B 线。
与标准透析液钠相比，低透析液钠时 48 小时收缩压/舒张压（SBP/DBP）明显更低（低透析液钠时为 137.6 ± 17.0/81.4 ± 13.7 mmHg，标准透析液钠时为 142.9 ± 14.5/84.0 ± 13.9 mmHg，P =.005/P =.007）；44 小时和不同 24 小时期间的 SBP/DBP 水平也明显较低。低透析液钠显著降低了透析后（SBP/DBP：低透析液钠时为 150.3 ± 22.3/91.2 ± 15.1 mmHg，标准透析液钠时为 166.6 ± 17.3/94.5 ± 14.9 mmHg，P <.001/P =.134）和透析中（SBP/DBP：低透析液钠时为 141.4 ± 18.0/85.0 ± 13.4 mmHg，标准透析液钠时为 147.5 ± 13.6/88.1 ± 12.5 mmHg，P =.034/P =.013）BP。与标准透析液钠相比，低透析液钠时透析前体重、IDWG 和透析前 B 线也显著减少。
与标准透析液钠相比，低透析液钠浓度可显著降低 IDH 患者的 48 小时动态血压。这些发现支持低透析液钠作为 IDH 患者血压管理的一种主要非药物治疗方法。
ClinicalTrials.gov 研究编号 NCT05430438。
