BackgroundIt 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. MethodsMEDLINE 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. ResultsTwenty-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. ConclusionsThere 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.

High versus low dialysate sodium concentration in chronic haemodialysis patients: A systematic review of 23 studies

Bolignano D.
2016-01-01

Abstract

BackgroundIt 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. MethodsMEDLINE 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. ResultsTwenty-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. ConclusionsThere 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.
2016
blood pressure; dialysate sodium concentration; haemodialysis; interdialytic weight gain; intradialytic complications; mortality; Blood Pressure; Chronic Disease; Dialysis Solutions; Diet, Sodium-Restricted; Hospitalization; Humans; Sodium; Weight Gain; Outcome Assessment, Health Care; Renal Dialysis
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12317/59791
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