Journal of the American Society of Nephrology, Vol 4, 1192-1198, Copyright © 1993 by American Society of Nephrology

REGULAR ARTICLES

Sodium modeling ameliorates intradialytic and interdialytic symptoms in young hemodialysis patients

RH Sadowski, EN Allred and K Jabs
Division of Nephrology, Children's Hospital and Harvard Medical School, Boston, MA.

Despite advances in the delivery of hemodialysis, significant dialytic morbidity persists. Sodium modeling in older adults has been shown to decrease some dialytic symptoms, but clear benefits in young patients without coexisting diabetes or advanced cardiovascular disease have not been shown. The effects of sodium modeling were evaluated in 16 adolescent and young adult hemodialysis patients (16 to 32 yr of age) treated with conventional hemodialysis for a median of 11.5 months. The 8-wk study was divided into four 2-wk blocks. During each block, one of three sodium programs or a constant (control) dialysate sodium of 138 mEq/L was used. During each sodium program, the initial dialysate sodium of 148 mEq/L was decreased by an exponential, linear, or step program to 138 mEq/L. Treatments with sodium modeling were significantly better than those with constant sodium dialysate. When all sodium programs were grouped and compared with constant dialysate sodium, the odds of improvement in dialytic cramps, headaches, and nausea were 1.8, 2.1, and 3.9, respectively (P < 0.05). Sodium modeling also significantly decreased the frequency of postdialysis hypotension and interdialytic fatigue, dizziness, and muscle cramping (P < 0.05). No differences were seen among the sodium protocols in the incidence of symptomatic hypotension, the amount of normal saline administered, the degree of hemo-concentration during treatments, or the decrease in serum osmolality. There was no increase in pretreatment or posttreatment serum sodium concentrations, interdialytic thirst, weight gain, or hypertension. Sodium modeling dramatically decreases both intradialytic and interdialytic morbidity in young hemodialysis patients. There was no increase in adverse events associated with sodium modeling.

This article has been cited by other articles:

				H. Thein, I. Haloob, and M. R. Marshall Associations of a facility level decrease in dialysate sodium concentration with blood pressure and interdialytic weight gain Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2630 - 2639. [Abstract] [Full Text] [PDF]

				Y. L. Zhou, H. L. Liu, X. F. Duan, Y. Yao, Y. Sun, and Q. Liu Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3231 - 3237. [Abstract] [Full Text] [PDF]

				J. H. Song, G. H. Park, S. Y. Lee, S. W. Lee, S. W. Lee, and M.-J. Kim Effect of Sodium Balance and the Combination of Ultrafiltration Profile during Sodium Profiling Hemodialysis on the Maintenance of the Quality of Dialysis and Sodium and Fluid Balances J. Am. Soc. Nephrol., January 1, 2005; 16(1): 237 - 246. [Abstract] [Full Text] [PDF]

				M. J. OLIVER, L. J. EDWARDS, and D. N. CHURCHILL Impact of Sodium and Ultrafiltration Profiling on Hemodialysis-Related Symptoms J. Am. Soc. Nephrol., January 1, 2001; 12(1): 151 - 156. [Abstract] [Full Text]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673