Abstract
Introduction:Excess sodium intake and consequent volume overload are major clinical problems in hemodialysis (HD) contributing to adverse outcomes. Saline used for priming and rinsing of the extracorporeal circuit is a potentially underappreciated source of intradialytic sodium gain. We aimed to examine the feasibility and clinical effects of replacing saline as the priming and rinsing fluid by a 5% dextrose solution.Materials and methods:We enrolled non-diabetic and anuric stable HD patients. First, the extracorporeal circuit was primed and rinsed with approximately 200–250 mL of isotonic saline during 4 weeks (Phase 1), subsequently a similar volume of a 5% dextrose solution replaced the saline for another 4 weeks (Phase 2), followed by another 4 weeks of saline (Phase 3). We collected data on interdialytic weight gain (IDWG), pre- and post-dialysis blood pressure, intradialytic symptoms, and thirst.Results:Seventeen chronic HD patients (11 males, age 54.1 ± 18.7 years) completed the study. The average priming and rinsing volumes were 236.7 ± 77.5 and 245.0 ± 91.8 mL respectively. The mean IDWG did not significantly change (2.52 ± 0.88 kg in Phase 1; 2.28 ± 0.70 kg in Phase 2; and 2.51 ± 1.2 kg in Phase 3). No differences in blood pressures, intradialytic symptoms or thirst were observed.Conclusions:Replacing saline by 5% dextrose for priming and rinsing is feasible in stable HD patients and may reduce intradialytic sodium loading. A non-significant trend toward a lower IDWG was observed when 5% dextrose was used. Prospective studies with a larger sample size and longer follow-up are needed to gain further insight into the possible effects of using alternate priming and rinsing solutions lowering intradialytic sodium loading.Trial registration:Identifier NCT01168947 (ClinicalTrials.gov).
Highlights
Excess sodium intake and consequent volume overload are major clinical problems in hemodialysis (HD) contributing to adverse outcomes
While designed as a pilot study, we investigated the effects on interdialytic weight gain (IDWG) as the primary outcome, and pre- and post-dialysis blood pressure (BP), intradialytic events, and self-reported thirst as the secondary outcomes
We assessed the relationship between the sodium content of the priming and rinsing solution and IDWG, blood pressure, and thirst in anuric, non-diabetic stable HD patients in this pilot study
Summary
Excess sodium intake and consequent volume overload are major clinical problems in hemodialysis (HD) contributing to adverse outcomes. The dietary sodium intake can be quite excessive and reportedly amount of up to 10 g of salt.[8] Another substantial source of sodium comes from the dialysis treatment itself, for example in the presence of a positive dialysate-to-serum sodium gradient leading to intradialytic diffusive sodium loading, or if saline solutions with sodium concentrations greater than the plasma sodium (normally saline solutions have sodium concentrations at around 154 mEq/L) are administrated during HD. The former may occur if the dialysate sodium concentration is higher than the serum sodium (dialyzing against a positive sodium gradient), and when certain sodium profiles are used for the prevention of intradialytic hemodynamic instability. The latter may occur when saline boluses are administrated to prevent or treat intradialytic symptoms.[7,8,9,10,11,12]
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