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Effect of low versus high dialysate sodium concentration on blood pressure and endothelial-derived vasoregulators during hemodialysis : a randomized crossover study . BACKGROUND Intradialytic hypertension affects ∼15 % of hemodialysis patients and is associated with increased morbidity and mortality . While intradialytic hypertension is associated with increases in endothelin 1 relative to nitric oxide ( NO ) , the cause of these imbalances is unknown . In vitro evidence suggests that altering plasma sodium levels could affect endothelial-derived vasoregulators and blood pressure ( BP ) . Thus , we hypothesized that compared to high dialysate sodium , low dialysate sodium concentration would lower endothelin 1 levels , increase NO release , and reduce BP . STUDY DESIGN 3-week , 2-arm , randomized , crossover study . SETTING & PARTICIPANTS 16 patients with intradialytic hypertension . INTERVENTION Low ( 5 mEq/L below serum sodium ) versus high ( 5 mEq/L above serum sodium ) dialysate sodium concentration . OUTCOMES Endothelin 1 , nitrite ( NO2 ( - ) ) , and BP . MEASUREMENTS Mixed linear regression was used to compare the effect of dialysate sodium ( low vs high ) and randomization arm ( low-then-high vs high-then-low ) on intradialytic changes in endothelin 1 , NO2 ( - ) , and BP values . RESULTS The average systolic BP throughout all hemodialysis treatments in a given week was lower with low dialysate sodium concentrations compared with treatments with high dialysate sodium concentrations ( parameter estimate , -9.9 [ 95 % CI , -13.3 to -6.4 ] mm Hg ; P < 0.001 ) . The average change in systolic BP during hemodialysis also was significantly lower with low vs high dialysate sodium concentrations ( parameter estimate , -6.1 [ 95 % CI , -9.0 to -3.2 ] mm Hg ; P < 0.001 ) . There were no significant differences in intradialytic levels of endothelin 1 or NO2 ( - ) with low vs high dialysate sodium concentrations . LIMITATIONS Carryover effects limited the power to detect significant changes in endothelial-derived vasoregulators , and future studies will require parallel trial designs . CONCLUSIONS Low dialysate sodium concentrations significantly decreased systolic BP and ameliorated intradialytic hypertension . Longer studies are needed to determine the long-term effects of low dialysate sodium concentrations on BP and clinical outcomes .
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Outcome_Physical
blood pressure and endothelial-derived vasoregulators
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Outcome_Physical
affect endothelial-derived vasoregulators and blood pressure ( BP )
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Outcome_Physical
lower endothelin 1 levels
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increase NO release
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reduce
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OUTCOMES Endothelin 1
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nitrite ( NO2 ( - ) )
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BP
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intradialytic changes in endothelin 1
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Outcome_Physical
NO2 ( - )
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BP values
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Outcome_Physical
The average systolic
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Outcome_Other
0.001
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Outcome_Physical
The average change in systolic BP during hemodialysis
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Outcome_Physical
differences in intradialytic levels of endothelin 1
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Outcome_Physical
changes in endothelial-derived vasoregulators
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significantly decreased systolic
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ameliorated intradialytic hypertension
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Outcome_Other
concentrations
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Participant_Sample-size
16 patients
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Participant_Condition
intradialytic hypertension