#496 Individualized approach in dialysate sodium prescription—safe and effective
Authors: Smokovska Nikolina , Misovska Nadica , Piperkoska Marija , Nikolov Ivica , Kostadinoska Srdanka , Stanoevska Suzana , Haarhaus Mathias 
Published: May 2024

Abstract

Background and Aims
The management of Na+ levels in hemodialysis (HD) patients plays a crucial role in maintaining their overall health and well-being. Na+, an essential electrolyte, is responsible for maintaining fluid balance, nerve function, and muscle contraction. However, in end-stage renal disease (ESRD) patients undergoing HD, Na+ imbalances are common and can have detrimental effects on their cardiovascular health. Furthermore, HD patients have been prescribed a standardized dialysis bath Na+ concentration (dNa+) during their HD sessions. The individualized approach aims to optimize Na+ balance, minimize adverse effects, and improve patient outcomes. Additionally, dietary Na+ intake, fluid status, and interdialytic weight gain (IDWG) also influence Na+ levels and should be considered when determining the appropriate Na+ prescription. The study aimed to assess whether an individualized dNa+ prescription can contribute to lower IDWG, expressed as a percent of prescribed dry weight (IDWG%).

Method
This retrospective, non-interventional study included all &gt;18-year-old patients undergoing hemodialysis for &gt;90 days at a single center. Patients were followed for a period of 18 months (December 2021–June 2023), during which the dNa+ concentration was gradually changed, as part of routine clinical care, until a gradient between plasma and dialysis bath Na+ of −2 mEq/L was achieved. Plasma Na+ levels were measured once monthly before a dialysis session along with other parameters such as IDWG and blood pressure.

Results
A total of 79 patients were enrolled in the study. The average age of the patients was 63.33 ± 12.1 years, with 43 (54.4%) being male. At baseline, the average duration of HD treatment was 255 ± 2.36 minutes, and the mean blood pump rate was 384.7 ± 42.81 ml/min. The majority of patients (98.8%) received HD treatments thrice weekly. Starting from January 2022, the mean dNa+ concentration decreased non-significantly from 139.39 ± 0.96 mmol/L to 138.99 ± 3.18 mmol/L, p = 0.13. The mean plasma Na+ concentration increased from 133.25 ± 2.9 to 136.59 ± 3.47 mmol/L, p &lt; 0.00001, and while mean systolic blood pressure increased slightly (118.38 ± 12.25 to 122.87 ± 12.43, p = 0.01), it remained well controlled. The mean IDWG% decreased from 3.53 ± 1.34%, to 2.74 ± 1.35%, p = 0.35 and the proportion of patients with IDWG &gt;5% decreased remarkably by more than half (11.4% to 5.1%), but due to the low patient numbers, the finding did not quite reach significance (p = 0.15, Table 1).

Conclusion
Our study demonstrates that individualized dNa+ management in HD patients is a beneficial approach, contributing to a decrease in the proportion of patients with severe IDWG increase, thereby addressing a crucial cardiovascular risk factor. Systolic blood pressure before dialysis remained well controlled, despite a slight, but significant increase. Our findings underscore the safety and potential benefits of an individualized approach to dialysate Na+ concentration, encouraging further exploration for enhanced HD patient care and increased overall well-being.