The following is a summary of “Low dialysate sodium and 48-h ambulatory blood pressure in patients with intradialytic hypertension: a randomized crossover study,” published in the May 2024 issue of Nephrology by Iatridi et al.

Intradialytic hypertension (IDH) raises risks for heart problems and death. It is linked to higher 48-h blood pressure (BP) levels during and after dialysis. Excess volume and sodium are thought to be critical factors. 

Researchers conducted a retrospective study analyzing how lower (137 mEq/L) than standard (140 mEq/L) dialysate sodium affects blood pressure over 48 hours in patients with IDH.

They conducted a randomized, single-blind, crossover study involving 29 patients with IDH. Each patient had 4 hemodialysis sessions with low (137mEq/L) and 4 with standard (140mEq/L) dialysate sodium or vice versa. The average 48-hour blood pressure, pressure before and after dialysis, weight gain between sessions, and lung ultrasound results.

The results showed that mean 48-hour systolic/diastolic blood pressure (SBP/DBP) was significantly lower with low dialysate sodium (137.6 ±17.0/81.4 ±13.7 mmHg, P=0.005) compared to standard (142.9 ±14.5/84.0 ±13.9 mmHg, P=0.007). Post-dialysis and intradialytic SBP/DBP were also lower with low dialysate sodium (150.3 ±22.3/91.2 ±15.1 mmHg vs 166.6 ±17.3/94.5 ±14.9 mmHg with standard dialysate sodium, P<0.001/P=0.134 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=0.034/P=0.013, respectively). Pre-dialysis weight, IDWG, and B-lines decreased significantly with low sodium.

Investigators concluded that low dialysate sodium can significantly lower 48-hour ambulatory blood pressure in patients with IDH. This suggests it’s a critical non-drug method for managing blood pressure in these patients.

Source: academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfae104/7665745