1. High versus low dialysate sodium concentration in chronic haemodialysis patients: a systematic review of 23 studies.
- Author
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Basile, Carlo, Pisano, Anna, Lisi, Piero, Rossi, Luigi, Lomonte, Carlo, and Bolignano, Davide
- Subjects
HEMODIALYSIS patients ,SODIUM ,ANTIHYPERTENSIVE agents ,HOSPITAL care ,MEDICAL care ,THERAPEUTICS - Abstract
Background. It is the object of debate whether a low or high dialysate sodium concentration (DNa
+ ) should be advocated in chronic haemodialysis patients. In this paper, we aimed at evaluating benefits and harms of different DNa+ prescriptions through a systematic review of the available literature. Methods. MEDLINE and CENTRAL databases were searched for studies comparing low or high DNa+ prescriptions. Outcomes of interest were mortality, blood pressure (BP), interdialytic weight gain (IDWG), plasma sodium, hospitalizations, use of anti-hypertensive agents and intradialytic complications. Results. Twenty-three studies (76 635 subjects) were reviewed. There was high heterogeneity in the number of patients analysed, overall study quality, duration of follow-up, DNa+ and even in the definition of 'high' or 'low' DNa+ . The only three studies looking at mortality were observational. The risk of death was related to the plasma-DNa+ gradient, but was also shown to be confounded by indication from the dialysate sodium prescription itself. BP was not markedly affected by high or low DNa+ . Patients treated with higher DNa+ had overall higher IDWG when compared with those with lower DNa+ . Three studies reported a significant increase in intra-dialytic hypotensive episodes in patients receiving low DNa+ . Data on hospitalizations and use of anti-hypertensive agents were sparse and inconclusive. Conclusions. There is currently no definite evidence proving the superiority of a low or high uniform DNa+ on hard or surrogate endpoints in maintenance haemodialysis patients. Future trials adequately powered to evaluate the impact of different DNa+ on mortality or other patient-centred outcomes are needed. [ABSTRACT FROM AUTHOR]- Published
- 2016
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