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document
Online conductivity monitoring : validation and usefulness in a clinical trial of reduced dialysate conductivity . Relatively low dialysate conductivity ( Cndi ) may improve outcomes by reducing the overall sodium burden in dialysis patients . Excess sodium removal , however , could lead to hemodynamic instability . We performed a randomized controlled trial of reduction of Cndi . For the study , 28 patients were randomized to maintenance of Cndi at 13.6 mS/cm ( equivalent to 135 mmol/L of Na+ ) or serial reduction of Cndi in steps of 0.2 mS/cm , guided by symptoms and blood pressure . Sodium removal estimated from pre- and postplasma concentrations correlated well with removal measured by conductivity monitoring as ionic mass balance ( R2 0.66 , p < 0.0001 ) . Of the 16 patients randomized to reduction of Cndi , 6 achieved Cndi 13.4 mS/cm , 6 achieved 13.2 mS/cm , and 4 achieved 13.0 mS/cm . No episodes of disequilibrium occurred . Interdialytic weight gain was reduced from 2.34 +/- 0.10 kg to 1.57 +/- 0.11 kg ( p < 0.0001 ) . Predialysis systolic blood pressure fell from 144 +/- 3 mm Hg to 137 +/- 4 mm Hg ( p < 0.05 ) . The reduction in convective sodium removal was balanced by an increase in diffusive sodium removal ( 95 +/- 9 mmol cf . 175 +/- 14 mmol , p < 0.0001 ) . Reduction in Cndi monitored by IMB is safe and practical and leads to improved interdialytic weight gains and blood pressure control , while avoiding excessive sodium removal .
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Intervention_Educational
Online conductivity monitoring
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Intervention_Educational
reduced dialysate conductivity
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Intervention_Educational
Relatively low dialysate conductivity ( Cndi )
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Intervention_Other
reduction of Cndi
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Intervention_Other
reduction of Cndi
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Outcome_Physical
sodium burden
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Outcome_Physical
ionic mass balance
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Outcome_Physical
Interdialytic weight gain
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Outcome_Physical
Predialysis systolic blood pressure
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Outcome_Physical
reduction in convective sodium removal
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Outcome_Physical
diffusive sodium removal
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Participant_Condition
dialysis
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Participant_Sample-size
28