Daily Sodium Intake in Anuric Hemodialysis Patients and Interdialytic Weight Gain

Study Overview
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Brief Summary
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This study will evaluate the efficiency of dietary intervention on intradialytic weight gain. Uniric hemodialysis patients without serious dietary complications, who accumulate above 2.5 kg (or above 4%) of their dry weight, will undergo a series of dietary consultations for sodium restriction. One month after the intervention, their intradialytic weight accumulation will be measured.

Detailed Description
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Inter Dialytic Weight Gain (IDWG) ascribed to fluid retention is one of the major clinical problem that patients in hemodialysis need to cope with between 2 subsequent hemodialysis especially in patients with no residual renal function. Fluid retention is associated with morbid conditions such as lower-extremity edema, ascites, pulmonary vascular congestion or edema, hypertension, and worsening heart failure. Gain weight above 2 kg between 2 subsequent hemodialysis found to be in higher risk of all-cause mortality and cardiovascular death .Lowering daily sodium intake found to mitigate fluid retention ,however there are only a few researches that check it. 2IDWG also associated with poorer quality of life. Dietary sodium restriction recommendation since the beginning of hemodialysis are based on association of this restriction with balance of hypertension and fluid retention. Sodium intake recommended for patients in hemodialysis is limited to 2 grams a day. Nevertheless, there are only a few studies that examine the efficiency of this restriction because of the complexity of measurement of sodium intake. One recently published study which used a 24-h recall to measure sodium intake, found a direct correlation between IDGW and mortality form any reason. In spite of this complexity, IDWG has been found to be in a direct relation with patients' nutrition status. One of sodium-related issues is malnutrition. Malnutrition in dialysis is a risk factor for patients' morbidity and mortality. Higher sodium intake is associated with higher calorie and protein intake, while adherence to restriction of sodium intake is poor in hemodialysis. This is a reason for high importance to study effects of sodium restriction in people with more than 2.5 kg (or 4% of dry body weight) IDWG while following up their nutritional status

Official Title
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Daily Sodium Intake in Anuric Hemodialysis Patients and Interdialytic Weight Gain

Conditions
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End Stage Kidney Disease

Intervention / Treatment
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* Other: Dietary consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults >18 years providing signed informed consent. Any patient more than 3 months in hemodialysis who reach his assigned dry weight. Intradialytic weight gain of more than 2.5 liters or 4% of dry body weight in two mid-week sessions. residual renal function of less than 200 ml per 24 hr. expected to stay on hemodialysis for at least 6 month. Exclusion Criteria: Malnutrition as assessed by SGA: score C. Dementia Active malignancy Active infection

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: arm 1<br>Unuric hemodialytic patients who accumulate above 2.5 (4%) in intradialytic intervals before the nutritional intervention. | Other: Dietary consultation<br>* Dietary consultation for sodium restriction to decrease dietary intake to 2 grams/day less than the patients consume currently<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reduction in intradialytic weight gain (IDWG) | Reduction in the weight gain at 2 subsequent hemodialysis in KG/ | between baseline and 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| dietary sodium intake. | as measured by food recall assesment | at baseline and 6 weeks | 
| Change in CRP values |  | between baseline and 6 weeks | 
| Changes in subjective global assesment (SGA) | SGA is a nutritional assesment measure | between baseline and 6 weeks | 
| change in predialysis blood pressure |  | between baseline and 6 weeks | 
| Changes in quality of life | assessed by SF 36 | between baseline and 6 weeks | 
| number of hypotensive episode during dialysis | define as drop of more than 20 mm hg systolic blood pressure from baseline | at baseline and 6 weeks |