Benjamin Thomson *,Lihua Li ,Robert Lindsay
Introduction and objectives: In thrice weekly conventional hemodialysis, dialysate sodium prescription can cause intradialytic plasma sodium shifts, and undesirable symptoms. However, changes in pre-dialysis plasma sodium setpoint are not observed. Whether these clinical observations are observed in quotidian or nocturnal home hemodialysis has not been prospectively evaluated. Methods: A randomized crossover study of conventional, quotidian and nocturnal home hemodialysis patients was performed. Dialysate sodium was personalized 3 mmol/L above (HIGHDIALSOD) or below (LOWDialSOD) the SP, with 100 days for each crossover studies period. Results: Plasma Na+ decreased during hemodialysis in LOWDialSOD study period (136.8 to 135.0 mmol/L, p=0.002). Pre-Na+ SP (137.4 to 136.8 mmol/L, p=0.03) and Pre-Na+ SP slope (0.014 to -0.015 mmol/L/day, p=0.009) decreased from HIGHDialSOD to LOWDialSOD study periods. Conclusions: Personalization of Dial-Na+ to below SP leads to reductions in plasma sodium concentration during hemodialysis, in conventional, quotidian and nocturnal home hemodialysis patients. Furthermore, sodium set point changes in response to Dial-Na+ prescription. This has the potential to lead to adverse outcomes in a patient population that is followed less frequently and stringently than the in-center hemodialysis population.
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