BACKGROUND: It is the object of debate whether a low or high dialysate sodium concentration (DNa(+)) should be advocated in chronic haemodialysis patients. In this paper, we aimed at evaluating benefits and harms of different DNa(+) prescriptions through a systematic review of the available literature. METHODS: MEDLINE and CENTRAL databases were searched for studies comparing low or high DNa(+) prescriptions. Outcomes of interest were mortality, blood pressure (BP), interdialytic weight gain (IDWG), plasma sodium, hospitalizations, use of anti-hypertensive agents and intradialytic complications. RESULTS: Twenty-three studies (76 635 subjects) were reviewed. There was high heterogeneity in the number of patients analysed, overall study quality, duration of follow-up, DNa(+) and even in the definition of 'high' or 'low' DNa(+). The only three studies looking at mortality were observational. The risk of death was related to the plasma-DNa(+) gradient, but was also shown to be confounded by indication from the dialysate sodium prescription itself. BP was not markedly affected by high or low DNa(+). Patients treated with higher DNa(+) had overall higher IDWG when compared with those with lower DNa(+). Three studies reported a significant increase in intra-dialytic hypotensive episodes in patients receiving low DNa(+). Data on hospitalizations and use of anti-hypertensive agents were sparse and inconclusive. CONCLUSIONS: There is currently no definite evidence proving the superiority of a low or high uniform DNa(+) on hard or surrogate endpoints in maintenance haemodialysis patients. Future trials adequately powered to evaluate the impact of different DNa(+) on mortality or other patient-centred outcomes are needed.
BACKGROUND: It is the object of debate whether a low or high dialysate sodium concentration (DNa(+)) should be advocated in chronic haemodialysis patients. In this paper, we aimed at evaluating benefits and harms of different DNa(+) prescriptions through a systematic review of the available literature. METHODS: MEDLINE and CENTRAL databases were searched for studies comparing low or high DNa(+) prescriptions. Outcomes of interest were mortality, blood pressure (BP), interdialytic weight gain (IDWG), plasma sodium, hospitalizations, use of anti-hypertensive agents and intradialytic complications. RESULTS: Twenty-three studies (76 635 subjects) were reviewed. There was high heterogeneity in the number of patients analysed, overall study quality, duration of follow-up, DNa(+) and even in the definition of 'high' or 'low' DNa(+). The only three studies looking at mortality were observational. The risk of death was related to the plasma-DNa(+) gradient, but was also shown to be confounded by indication from the dialysate sodium prescription itself. BP was not markedly affected by high or low DNa(+). Patients treated with higher DNa(+) had overall higher IDWG when compared with those with lower DNa(+). Three studies reported a significant increase in intra-dialytic hypotensive episodes in patients receiving low DNa(+). Data on hospitalizations and use of anti-hypertensive agents were sparse and inconclusive. CONCLUSIONS: There is currently no definite evidence proving the superiority of a low or high uniform DNa(+) on hard or surrogate endpoints in maintenance haemodialysis patients. Future trials adequately powered to evaluate the impact of different DNa(+) on mortality or other patient-centred outcomes are needed.
Authors: Mark R Marshall; Alain C Vandal; Janak R de Zoysa; Ruvin S Gabriel; Imad A Haloob; Christopher J Hood; John H Irvine; Philip J Matheson; David O R McGregor; Kannaiyan S Rabindranath; John B W Schollum; David J Semple; Zhengxiu Xie; Tian Min Ma; Rose Sisk; Joanna L Dunlop Journal: J Am Soc Nephrol Date: 2020-03-18 Impact factor: 10.121
Authors: Adrianna Douvris; Gurpreet Malhi; Swapnil Hiremath; Lauralyn McIntyre; Samuel A Silver; Sean M Bagshaw; Ron Wald; Claudio Ronco; Lindsey Sikora; Catherine Weber; Edward G Clark Journal: Crit Care Date: 2018-02-22 Impact factor: 9.097
Authors: Jennifer E Flythe; Tara I Chang; Martin P Gallagher; Elizabeth Lindley; Magdalena Madero; Pantelis A Sarafidis; Mark L Unruh; Angela Yee-Moon Wang; Daniel E Weiner; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Kevan R Polkinghorne Journal: Kidney Int Date: 2020-03-08 Impact factor: 10.612
Authors: James A Tumlin; Prabir Roy-Chaudhury; Bruce A Koplan; Alexandru I Costea; Vijay Kher; Don Williamson; Saurabh Pokhariyal; David M Charytan Journal: BMC Nephrol Date: 2019-03-05 Impact factor: 2.388