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Sodium ramping reduces hypotension and symptoms during haemodialysis
HL Tang, SH Wong, KH Chu, W Lee, A Cheuk, CMK Tang, ILL Kong, KS Fung, WK Tsang, HWH Chan, KL Tong
Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong
OBJECTIVES. To evaluate the effectiveness of sodium
ramping (profiling) in reducing hypotensive episodes and symptoms
during haemodialysis.
DESIGN. Prospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Thirteen patients who experienced frequent
episodes of hypotension and/or symptoms such as cramps, dizziness,
chest pain, nausea, vomiting, and headache during haemodialysis
in the preceding 4 weeks.
INTERVENTIONS. Each patient was switched from standard
haemodialysis with a constant dialysate sodium concentration of
135 to 140 mmol/L to a ramped sodium haemodialysis for a period
of 4 weeks. During this time the dialysate sodium concentration
was ramped linearly downwards from 150 mmol/L at the beginning of
dialysis to 140 mmol/L at the end of dialysis.
MAIN OUTCOME MEASURES. Intradialytic hypotensive
episodes, intradialytic symptoms, nursing interventions, systolic
and diastolic blood pressures, and interdialytic weight gain.
RESULTS. A total of 248 haemodialysis sessions undertaken
by 13 patients were analysed. Switching from constant sodium haemodialysis
to ramped sodium haemodialysis resulted in a significant reduction
in the number of intradialytic hypotensive episodes from 5.8 (standard
deviation, 6.4) to 2.2 (3.3) [P<0.05], the total number of intradialytic
symptoms from 7.1 (3.4) to 0.9 (1.3) [P<0.01], and nursing interventions
from 11.3 (6.3) to 1.7 (3.9) [P<0.01]. Post-dialysis systolic
and diastolic blood pressures were higher during ramped sodium haemodialysis
compared with constant sodium haemodialysis (systolic blood pressure,
139 [standard deviation, 23] vs 133 [22] mm Hg, P<0.001; diastolic
blood pressure, 77 [11] vs 74 [13] mm Hg, P<0.01), and there
was a trend towards a smaller drop in blood pressure after dialysis.
The interdialytic weight gain with sodium ramping haemodialysis
was greater compared with constant sodium haemodialysis (3.1 [standard
deviation, 1.0] vs 2.7 [1.1] kg, P<0.001).
CONCLUSION. Sodium ramping during haemodialysis
effectively reduces hypotensive episodes and intradialytic symptoms.
Post-dialysis blood pressure is better maintained. A side-effect
of sodium ramping is a greater interdialytic weight gain.
Hong Kong Med J 2006;12:10-4
Key words: Blood pressure; Hemodialysis solutions; Kidney failure, chronic; Renal dialysis; Sodium
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