Bratsiakou Adamantia, Iatridi Fotini, Theodorakopoulou Marieta, Sarafidis Pantelis, Goumenos Dimitrios S, Papachristou Evangelos, Papasotiriou Marios
Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece.
First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clin Kidney J. 2024 Feb 21;17(8):sfae041. doi: 10.1093/ckj/sfae041. eCollection 2024 Aug.
Hypertension is associated with increased morbidity and mortality in hemodialysis patients. Existing recommendations suggest reduction of sodium load, but the effect of dialysate sodium on blood pressure (BP) is not fully elucidated. The aim of the present study is to investigate the effect of different dialysate sodium concentrations on 72-h ambulatory BP in hemodialysis patients.
This prospective study included patients on standard thrice-weekly hemodialysis. All patients initially underwent six sessions with dialysate sodium concentration of 137 meq/L, followed consecutively by another six sessions with dialysate sodium of 139 meq/L and, finally, six sessions with dialysate sodium of 141 meq/L. At the start of the sixth hemodialysis session on each sodium concentration, 72-h ABPM was performed over the long interdialytic interval to evaluate ambulatory systolic and diastolic BP (SBP and DBP) during the overall 72-h, different 24-h, daytime and night-time periods.
Twenty-five patients were included in the final analysis. A significant increase in the mean 72-h SBP was observed with higher dialysate sodium concentrations (124.8 ± 16.6 mmHg with 137 meq/L vs 126.3 ± 17.5 mmHg with 139 meq/L vs 132.3 ± 19.31 mmHg with 141 meq/L, = 0.002). Similar differences were noted for DBP; 72-h DBP was significantly higher with increasing dialysate sodium concentrations (75.1 ± 11.3 mmHg with 137 meq/L vs 76.3 ± 13.7 mmHg with 139 meq/L vs 79.5 ± 13.9 mmHg with 141 meq/L dialysate sodium, = 0.01). Ambulatory BP during the different 24-h intervals, daytime and night-time periods was also progressively increasing with increasing dialysate sodium concentration.
This pilot study showed a progressive increase in ambulatory BP with higher dialysate sodium concentrations. These findings support that lower dialysate sodium concentration may help towards better BP control in hemodialysis patients.
高血压与血液透析患者发病率和死亡率的增加相关。现有建议提出减少钠负荷，但透析液钠对血压（BP）的影响尚未完全阐明。本研究的目的是调查不同透析液钠浓度对血液透析患者72小时动态血压的影响。
这项前瞻性研究纳入了每周进行三次标准血液透析的患者。所有患者最初接受6次透析液钠浓度为137 meq/L的治疗，随后连续接受6次透析液钠浓度为139 meq/L的治疗，最后接受6次透析液钠浓度为141 meq/L的治疗。在每种钠浓度下的第六次血液透析治疗开始时，在较长的透析间期进行72小时动态血压监测（ABPM），以评估整个72小时、不同的24小时、白天和夜间时段的动态收缩压和舒张压（SBP和DBP）。
25名患者纳入最终分析。随着透析液钠浓度升高，观察到72小时平均SBP显著升高（透析液钠浓度为137 meq/L时为124.8±16.6 mmHg，139 meq/L时为126.3±17.5 mmHg，141 meq/L时为132.3±19.31 mmHg，P = 0.002）。DBP也有类似差异；随着透析液钠浓度增加，72小时DBP显著升高（透析液钠浓度为137 meq/L时为75.1±11.3 mmHg，139 meq/L时为76.3±13.7 mmHg，141 meq/L时为79.5±13.9 mmHg，P = 0.01）。不同24小时间隔、白天和夜间时段的动态血压也随着透析液钠浓度增加而逐渐升高。
这项初步研究表明，随着透析液钠浓度升高，动态血压逐渐升高。这些发现支持较低的透析液钠浓度可能有助于更好地控制血液透析患者的血压。
