High Interdialytic Weight Gain Research Articles

#2887 Interdialytic weight gain and low dialysate sodium concentration in patients on chronic hemodialysis: a systematic review and meta-analysis

Abstract Background and Aims In many patients on chronic hemodialysis, interdialytic weight gain (IDWG) is greater than 4.0%-4.5% of dry weight, the value recommended by the international guidelines. High IDWG is a condition associated with risk of all-cause mortality and hospitalization and it depends on elevate intake of fluids and/or foods. More specifically, high intake of water is secondary to the disturbing and constant presence of thirst in such patients, so the limitation of the IDWG is a challenge both for the patients and the physicians. Low dialysate sodium levels can significantly reduce thirst as well as the water intake in the interdialytic period because they can increase the removal of sodium during the dialytic session, and this leads to a reduced content of sodium in the body. The present systematic review and meta-analysis aims at evaluating the efficacy of low dialysate sodium concentration on interdialytic weight gain (IDWG) in chronic hemodialysis patients. Method Studies were eligible for inclusion if they were English language papers published in a peer-reviewed journal and met the following inclusion criteria: 1) Primary research studies in adult patients (over 18 years of age), 2) Included patients with end-stage renal disease on chronic hemodialysis since at least 6 months; 3) Compared standard (138-140 mmol/l) or high (>140 mmol/l) dialysate sodium concentration with low (<138 mmol/l) dialysate sodium concentration; 4) Included one outcome of interest: interdialytic weight gain. We excluded studies on pediatric patients, pre-dialysis CKD patients, acute kidney injury patients, ESRD patients with other renal replacement therapy modalities such as peritoneal dialysis and transplant. Medline, PubMed, Web of Science, and the Cochrane Library were searched for studies comparing low or high dialysate sodium concentration. Outcome of interest was IDWG. The quality of reporting for each study was performed using the Quality Assessment Tool of Controlled Intervention Studies of the National Institutes of Health. The quality of reporting of each cross-over study was performed using the Revised Cochrane Risk of Bias (RoB) tool for cross-over trials as proposed by Ding et al. Results Nineteen studies (710 patients) were included in the analysis: 15 were cross-over and 4 parallel randomized controlled studies. In cross-over studies, pooled analysis revealed that dialysate sodium concentration reduced IDWG with a pooled MD of −0.40 kg (95% CI -0.50 to −0.30; P < 0.00001). The systematic review of four parallel, randomized, studies revealed that the use of a low dialysate sodium concentration was associated with a significant reduction of the IDWG in two studies, sustained and almost significant (P=0.05) reduction in one study, and not significant reduction in one study. In most studies, the frequency of intradialytic hypotensive events did not differ significantly between low and high sodium dialysate hemodialysis. The GRADE methodology was used to assess the quality of the body of retrieved evidence and studies risk of bias, inconsistency and imprecision were estimated as low. Conclusion Low dialysate sodium concentration reduces the IDWG in patients on chronic hemodialysis.

#2916 Interdialytic weight gain and low-salt diet in patients on chronic hemodialysis: a systematic review and meta-analysis

Abstract Background and Aims Interdialytic weight gain (IDWG) is one of the most important indicators of the patient status in chronic hemodialysis: it is correlated with fluid and/or food intake and it is assessed at the beginning of the dialysis session being an easily measurable parameter. High IDWG is associated with risk of all-causes mortality and hospitalization; furthermore, high IDWG leads to supplementary dialysis sessions with consequent reduction of the quality of life and increase of the costs. Numerous barriers have been shown to determine failure to adherence to diet and fluid restrictions such as lack of self-assessment. The present systematic review and meta-analysis tries to determine the differences in the IDGW between low salt diet and normal/high salt diet, and between nutritional counseling aimed at reducing salt intake and no nutritional counseling in patients on chronic hemodialysis. Method Medline, PubMed, Web of Science, and the Cochrane Library were searched for studies comparing subjects who experienced educational or psychological interventions to untreated control patients. Outcome of interest was IDWG. Results Eight articles (783 patients) were fully assessed for eligibility and included in the investigation. The meta-analysis showed patients that after dialysis increased their weight more than 2.5 Kg over total enrolled subjects for each group (control and experimental). As no significant heterogeneity was observed (I2 =8%; p=0.36), the pooled analysis was performed using a fixed-effect model. Funnel plot was generated and no obvious asymmetry was observed, which indicates no clear evidence of publication bias. The Overall Odds Ratio to get an event in the experimental group, in respect to controls, is 0.57 (0.33-0.97) (p=0.04] with single studies OR ranging between 0.11 to 1.08, the last derived by a peculiar result reported in the Sevick's manuscript referring an identical IDGW of 1.1 Kg for both groups and an extremely narrow IQ range (1.0-1.2); therefore, in this case, the estimated number of events (patients with IDGW > 2.5 Kg) was rounded up to 1. Conclusion The present systematic review and meta-analysis suggest that the use of a low salt diet and/or a nutritional counseling aimed at reducing salt intake are associated with a statistically significant reduction of the IDWG in patients on chronic hemodialysis.

Socioeconomic, clinical and nutritional factors on interdialytic weight gain in haemodialysis users

Socioeconomic, clinical and nutritional factors on interdialytic weight gain in haemodialysis users

PS-BPC04-1: CHARACTERISTICS OF MONTH-BY-MONTH BLOOD PRESSURE VARIABILITY IN HEMODIALYSIS PATIENTS

Objectives: It is well known that blood pressure (BP) exhibits BP variation in patients with hemodialysis (HD). We have previously reported that high visit-to-visit blood pressure variability is independently correlated with cardiovascular mortality in maintenance HD patients. However, the characteristics of long-term BP variability remains to be elucidated in these patients. The present study, therefore aimed to investigate the characteristics of month-by-month blood pressure variability, as an indicator of long-term blood pressure variability, and the relationship between month-by-month blood pressure variability and cardiovascular mortality in these patients. Design and method: A total of 324 maintenance HD patients, who could be followed for 60 months, were recruited. We used variation independent of the mean (VIM), which was estimated using systolic BP (SBP) in pre-dialysis and post-dialysis at the beginning of the month in 12 consecutive months (pre-VIM-SBP and post-VIM-SBP), as an index of month-by-month BP variability. We also estimated the average of 12 values of differences between the highest and lowest SBP values during a dialysis session (average Δ SBP) and the difference between SBP in January and February and SBP in July and August (seasonal variability of SBP). We investigated (1) the reproducibility of these values, (2) the relationship between these values and background factors, and (3) the association between these values and mortality. Results: (1) Pre-VIM-SBP and post-VIM-SBP showed significant reproducibility (intraclass correlation, 0.456 (P < 0.001) and 0.522 (P < 0.001), respectively]. Seasonal variability of pre-SBP and Δ SBP was observed both at beginning / after 12 months [5.0 (-5.0–19.0) / 5.3 ± 18.3, 7.2 ± 16.7 / 5.0 ± 12.8, respectively]. (2) Higher pre-VIM-SBP was associated with higher interdialytic weight gain and poor nutritional status. Higher post-VIM-SBP was associated with glucose intolerance, higher interdialytic weight gain and poor nutritional status. Higher Δ SBP was associated with glucose intolerance and higher interdialytic weight gain. (3) Higher post-VIM-SBP was associated with a higher rate of cardiovascular deaths independent of other factors (hazard ratio: 1.104, 95% confidence interval: 1.011–1.207, P = 0.028). Conclusions: Month-by-month blood pressure variability in HD patients is reproducible and associated with various background factors. Month-by-month blood pressure variability in post-dialysis SBP is independently correlated with cardiovascular mortality. Further studies are necessary to confirm the mechanism of increased month-by-month blood pressure variability and to clarify whether reducing month-by-month blood pressure variability will improve the prognosis for HD patients.

Characteristics of Month-by-Month Blood Pressure Variability in Patients on Hemodialysis

Introduction: Poor prognosis in hemodialysis (HD) patients is due to the increased prevalence of cardiovascular diseases among them. We previously reported that higher visit-by-visit blood pressure variability is associated with increased cardiovascular mortality in HD patients. This present study aimed to investigate the characteristics of month-by-month blood pressure variability (MMBPV) in these patients. Methods: A total of 324 maintenance HD patients, who could be followed up for 60 months, were recruited. We used standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) in pre- and post-dialysis systolic blood pressure (pre- and post-SD, pre- and post-CV, and pre- and post-VIM) as an index of MMBPV. We investigated (1) the reproducibility of MMBPV, (2) relationship between these values and background factors, and (3) association between these values and mortality. Results: MMBPV (pre- and post-SD, pre- and post-CV, and pre- and post-VIM) showed significant reproducibility (intraclass correlation, 0.483 [p < 0.001], 0.553 [p < 0.001], 0.450 [p < 0.001], 0.518 [p < 0.001], 0.456 [p < 0.001], and 0.522 [p < 0.001], respectively). High pre-VIM was associated with high interdialytic weight gain and poor nutritional status. High post-VIM was associated with glucose intolerance, high interdialytic weight gain, and poor nutritional status and associated with high rate of cardiovascular deaths independent of other factors (hazard ratio: 1.104, 95% confidence interval: 1.011–1.207, p = 0.028). Conclusion: These data suggested that pre- and post-VIM in HD patients are reproducible and associated with various background factors, and especially post-VIM is independently correlated with cardiovascular mortality. Further studies are necessary to confirm the mechanism of increased post-VIM and clarify whether reducing post-VIM can improve the prognosis of HD patients.

Interdialytic Weight Gain as the side effect of Hemodialysis Therapy: A Literature Review

Patients with Chronic Kidney Disease undergo kidney replacement therapy, one of which is hemodialysis. In patients with end-stage CKD, the physiological functions of the kidneys are reduced so that the kidneys are no longer able to regulate urine output. The kidneys response to changes in fluid and sodium intake is not functioning as it should. Excess fluid intake between the two hemodialysis therapies as indicated by an increase in body weight is known as Interdialytic Weight Gain (IDWG). High interdialytic weight gain is associated with poor survival and increased mortality, one of which is due to disorders of the cardiovascular system, edema, heart failure, and hypertension. This literature study aims to identify IDWG as the side effect of therapy as well as the complications that may arise from it.

Application of evidence based practice: Interdialytic weight gain (IDWG) management intervention in hemodialysis patients at Arifin Hospital, Riau

The physical problem that is often experienced by hemodialysis (HD) patients and is difficult to overcome is the problem of excess fluid. This can be seen from the patient's weight gain between dialysis times or called interdialytic weight gain (IDWG). A high IDWG is associated with a higher risk of cardiovascular causes of death and increased morbidity. The application of evidence based practice in the form of IDWG management interventions has been proven to be able to overcome excessive weight gain between the two HD or IDWG times. The purpose of this community service is to increase the knowledge and skills of HD patients regarding evidence based practice in the form of IDWG management interventions. The method of implementing community service activities is in the form of training packaged with HD patients on IDWG management with lectures, questions and answers, and demonstrations. The resulting impact is an increase in the knowledge and skills of HD patients regarding IDWG management with a standard percentage of IDWG weight gain of 22% and IDWG weight loss &gt;3.5% of 14% after implementing IDWG management. In addition, the patient has been able to apply techniques to overcome thirst and xerosemia. Nurses and the patient's family must take part in providing support for patient compliance in implementing IDWG management so that patients can avoid complications from excess fluid problems which can ultimately improve the patient's quality of life.

Self-Efficacy and Compliance Fluid Intake Restriction as a Determinant of The Interdialytic Weight Gain (IDWG) Level

Higher interdialytic Weight Gain (IDWG) is commonly experienced by patients with chronic kidney disease (CKD). Increased IDWG can cause various complications that result in risk of death. CKD patients who had undergoing hemodialysis in the Public Regional Hospital of Indramayu would have different weight gain, but it is not known what factors affect the increase in IDWG. The purpose of this study was to determine the factors that were significantly related to the IDWG level in CKD patients in the Public Regional Hospital of Indramayu. This research design is descriptive-analytic. The number of samples was 86 respondents who were selected by consecutive sampling technique. Data collection tools are questionnaires and the data analysis technique is the Pearson chi-square test. From the result from 86 respondents, it is known that 44 (51.2%) respondents experienced an increase in IDWG level at the mild category (&lt;4%). It is known that the factor influencing to level of IDWG are self-efficacy (p-value = 0.000; 95% CI) and fluid intake compliance (p-value = 0.042; 95% CI). Meanwhile, age, sex, education level, family support, and duration of hemodialysis are not influencing the IDWG level (p-value &gt; 0,05; 95% CI). Self-efficacy and fluid intake compliance are the most significant factor on the IDWG level in CKD patients who had hemodialization. Patients with high self-efficacy can reduce the IDWG level accompanied by compliance with fluid restriction. Recommendation for hemodialysis nurses needs to increase the patient’s self-efficacy in limiting fluid so that can be controlled at the IDWG level.

The Nephrologist's Role in the Collaborative Multi-Specialist Network Taking Care of Patients with Diabetes on Maintenance Hemodialysis: An Overview.

Diabetes mellitus is the leading cause of renal failure in incident dialysis patients in several countries around the world. The quality of life for patients with diabetes in maintenance hemodialysis (HD) treatment is in general poor due to disease complications. Nephrologists have to cope with all these problems because of the “total care model” and strive to improve their patients’ outcome. In this review, an updated overview of the aspects the nephrologist must face in the management of these patients is reported. The conventional marker of glycemic control, hemoglobin A1c (HbA1c), is unreliable. HD itself may be responsible for dangerous hypoglycemic events. New methods of glucose control could be used even during dialysis, such as a continuous glucose monitoring (CGM) device. The pharmacological control of diabetes is another complex topic. Because of the risk of hypoglycemia, insulin and other medications used to treat diabetes may need dose adjustment. The new class of antidiabetic drugs dipeptidyl peptidase 4 (DPP-4) inhibitors can safely be used in non-insulin-dependent end-stage renal disease (ESRD) patients. Nephrologists should take care to improve the hemodynamic tolerance to HD treatment, frequently compromised by the high level of ultrafiltration needed to counter high interdialytic weight gain. Kidney and pancreas transplantation, in selected patients with diabetes, is the best therapy and is the only approach able to free patients from both dialysis and insulin therapy.

Effects of Electrical Stimulation of Acupoints on Xerostomia for Patients Who Undergo Hemodialysis.

Xerostomia plays a major role in higher interdialytic weight gain (IDWG), which causes cardiovascular complications in patients who undergo hemodialysis. However, few studies have determined a method to manage xerostomia. This study determines the effect of transcutaneous electrical acupoint stimulation (TEAS) on hemodialysis patients with xerostomia and the percentage of IDWG. The study was a single-blind and quasi-experimental study. There are 75 participants: 37 in the TEAS group and 38 in the contrast group. The TEAS group used 250 µs and 50 Hz and the contrast group used 50 µs and 2 Hz three times a week for 3 weeks to stimulate ST 6 and TE17 acupoints. The salivary flow rates, dry mouth, and %IDWG were determined before, during and one week after the program. Compared with the contrast group, the TEAS group showed a significantly improved salivary flow rate (mL/min) (F (2, 123) = 15.28, p < 0.0001), and patients recovered their normal salivary flow rate. However, the results show that both groups showed significant improvement in dry mouth after treatment. The TEAS group demonstrated no effect in terms of %IDWG, as expected. The results show that a TEAS program is an effective means of symptom management for xerostomia patients who undergo hemodialysis. A TEAS program can be used to manage symptoms for xerostomia patients who undergo hemodialysis.

POS-591 RELATIONSHIP BETWEEN INTERDIALYTIC WEIGHT GAIN WITH MORTALITY IN PATIENTS THAT WAS ROUTINED HEMODIALYSIS IN DR. RAMELAN NAVAL CENTRAL HOSPITAL SURABAYA

Chronic Kidney Disease (CKD) is a public health problem worldwide. Excessive interdialytic weight gain (IDWG) is usually related to an overload of sodium and water. Higher IDWG is associated with higher predialysis blood pressure and increased mortality. Analytical descriptive research was conducted on 99 CKD patients undergoing routine hemodialysis at Dr. Ramelan Naval Central Hospital, Surabaya. Data obtained from medical records. Descriptive analysis was performed by calculating the mean and standard deviation, and determining the relationship between IDWG and mortality in patients undergoing routine hemodialysis. The mean IDWG (kg) of patients was 2.07±1.42. The incidence of patient deaths was nine patients. There was no relationship between IDWG and mortality in patients undergoing routine hemodialysis (p=0.70; r=-0.04). There is no relationship between IDWG and mortality in patients undergoing routine hemodialysis.

POS-586 RELATIONSHIP BETWEEN DURATION OF ROUTINE HEMODIALYSIS AND INTERDIALYTIC WEIGHT GAIN IN CHRONIC KIDNEY DISEASE PATIENTS IN DR. RAMELAN NAVAL CENTRAL HOSPITAL SURABAYA

Chronic Kidney Disease (CKD) is a public health problem worldwide. Excessive interdialytic weight gain (IDWG) is usually related to an overload of sodium and water. Higher IDWG is associated with higher predialysis blood pressure and increased mortality. The purpose of this study was to determine whether there is a relationship between duration of routine hemodialysis and interdialytic weight gain in patients with CKD.

Prognostic Value of the Malnutrition-inflammation Score in Hospitalization and Mortality on Long-term Hemodialysis

Since its development, cumulative evidence has accumulated regarding the prognostic value of the Malnutrition-Inflammation Score (MIS/Kalantar score) prognostic value; however, there is a shortage of recent and large studies with comprehensive statistical methodologies that contribute to support a higher level of evidence and a consensual cutoff. The aim of this study was to assess the strength of MIS association with hospitalization and mortality in a nationwide cohort. This was a historical cohort study of hemodialysis patients from 25 outpatient centers followed up for 48months. Univariable and multivariable Cox additive regression models were used to analyze the data. The C-index was estimated to assess the performance of the final model. Two thousand four hundred forty-four patients were analyzed, 59.0% males, 32.0% diabetic, and median age of 71years (P25=60, P75=79). During a median period of 45-month follow-up, with a maximum of 48months (P25=31; P75=48), 875 patients presented an MIS <5 (35.8%) and 860 patients (35.2%) died. The proportion of deaths was 23.1% for patients with the MIS <5 and 41.9% if the MIS ≥5 (P<.001). A total of 1,528 patients (62.5%) were hospitalized with a median time to the first hospitalization of 26months (P25=9; P75=45). A new cutoff point regarding the risk of death, MIS ≥6, was identified for this study data set. In multivariable analysis for hospitalization risk, a higher MIS, higher comorbidity index, and arteriovenous graft or catheter increased the risk, whereas higher Kt/V and higher albumin had a protective effect. In multivariable analysis for mortality risk, adjusting for age, albumin, normalized protein catabolic rate, Charlson comorbidity index, interdialytic weight gain, Kt/V, diabetes, hematocrit, and vascular access, patients with the MIS ≥6 showed a hazard ratio of 1.469 (95% confidence interval: 1.262-1.711; P<.001). Higher age, higher interdialytic weight gain, higher comorbidity index, and catheter increased significantly the risk, whereas higher Kt/V, higher albumin, and higher normalized protein catabolic rate (≥1.05g/kg/d) reduced the risk. The MIS maintains its relevant and significant association with hospitalization and mortality.

Sodium Dialysate Prescription in a New Dialysis Facility

As the Medical Director of this new dialysis facility, I recommend a fixed sodium dialysate (Nadial) concentration at 138 mEq/L. This relates to my former experience in the Tassin unit in France and the fear of sodium as a powerful uremic toxin. I realize that, according to the Na+ set-point theory, a fixed value of the Nadial may create a plasma–dialysate (P–D) gradient and may favor intradialytic plasma Na+ changes. In cases where this is associated with signs of negative Na+ balance (bad session tolerance/quality of life) or positive Na+ balance (high interdialytic weight gain or high blood pressure), individualization of the Nadial to reduce the P–D gradient and change in plasma Na+ concentration may be useful, even though evidence remains scarce. I look forward to the possibility of using new dialysis machines that allow for the evaluation of sodium balance and tailoring of the sodium diffusion process.

Evaluation of demographic and clinical risk factors for high interdialytic weight gain.

Xerostomia and hyposalivation are highly prevalent in hemodialysis (HD) patients and this is effective in increased fluid intake. The aim of this study is to determine the demographic and clinical risk factors associated with high interdialytic weight gain (IDWG) in nondiabetic HD patients. In total, 52 eligible HD patients were recruited in this cross-sectional study. Patients were divided into two groups according to % IDWG: Group 1: High IDWG (≥3%) and Group 2: normal IDWG (<3%). Plasma osmolarity (POsm), unstimulated salivary flow rate (USFR), xerostomia inventory (XI), and dialysis thirst inventory (DTI) were evaluated. The mean age of the patients was 53.7 ± 15.7 years. The prevalence of xerostomia was 53.8%, and hyposalivation was in 40.3% in the patients. High IDWG was positively correlated with XI and DTI while it was negatively correlated with POsm and USFR. The area under the receiver-operating characteristics curve for POsm for high IDWG was 0.661, with sensitivity of 63.8% and specificity of 72.7% for a cut-off point of 297.4mOsm/L. Logistic regression analysis showed that advanced age odds ratio (OR: 1.215, p= 0.019), pill burden (OR: 1.162, p= 0.031), C-reactive protein (CRP; OR: 1.308, p= 0.042), and low POsm (OR: 0.768, p= 0.046) were independently related to high IDWG. The prevalence of xerostomia and thirst was higher in HD patients with high IDWG compared to the normal IDWG group. Age, CRP, low POsm, and pill burden were independently associated with high IDWG.

Correlation between Hypervolemia, Left Ventricular Hypertrophy and Fibroblast Growth Factor- 23 in Prevalent Hemodialysis Patients

Abstract Background Patients with end-stage renal disease are exposed to extreme volume shifts and thereby cardiovascular strain as a consequence of interdialytic weight gain, fluid removal during hemodialysis and also chronic fluid overload. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) is associated with poor survival and increased cardiovascular death. Patients with the lowest interdialytic fluid retention have the greatest survival. It was found that increased interdialytic volume load is associated with increased both LVMI and FGF-23 level. Objective To evaluate correlation between hypervolemia, left ventricular hypertrophy and FGF-23 in prevalent hemodialysis patients. Patients and Methods This cross sectional study was conducted in Ain shams university hospital and Al Agoza hospital, on 60 prevalent hemodialysis patients.Three patient died during the study. Results FGF-23 had a positive correlation with (weight gain, (PO4)3-, PTH, IVS, PW and LVMI). Conclusion FGF-23 might be a marker of volume overload and LVH in ESRD patients, as it positively correlated with (weight gain, IVS, PW and LVMI). FGF-23 is a marker of bone diseases, as it positively correlated with (PO4)3- and PTH. Volume overload has a negative impact on morbidity and mortality in ESRD patients.

Ultrafiltration rate adjusted to body weight and mortality in hemodialysis patients

Background and aimsMortality among hemodialysis patients remains high. An elevated ultrafiltration rate adjusted by weight (UFR/W) has been associated with hypotension and higher risk of death and/or cardiovascular events. MethodsWe evaluated the association between UFR/W and mortality in 215 hemodialysis patients. The mean follow-up was 28 ± 6.12 months. We collected patients’ baseline characteristics and mean UFR/W throughout the follow-up. ResultsMean UFR/W was 9.0 ± 2,4 and tertiles 7.1 y 10.1 mL/kg/h. We divided our population according to the percentage of sessions with UFR/W above the limits described in the literature associated with increased mortality (10.0 ml/kg/h and 13.0 mL/kg/h). Patients with higher UFR/W were younger, with higher interdialytic weight gain and weight reduction percentage but lower dry, pre and post dialysis weight. Throughout the follow-up, 46 (21.4%) patients died, the majority over 70 years old, diabetic or with cardiovascular disease. There were neither differences regarding mortality between groups nor differences in UFR/W among patients who died and those who did not. Contrary to previous studies, we did not find an association between UFR/W and mortality, maybe due to a higher prevalence in the use of cardiovascular protection drugs and lower UFR/W. ConclusionsThe highest UFR/W were observed in younger patients with lower weight and were not associated with an increased mortality.

Association between dialysate sodium concentration and interdialytic weight gain in patients undergoing twice weekly haemodialysis

BackgroundChronic kidney disease is highly prevalent across the globe with more than 2 million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.MethodsThis study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137 meq/l and 140 meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data.ResultsForty-one patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137 meq/l group and 2.35 for the 140 meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137 meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140 meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137 meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140 meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively).ConclusionThere was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain or blood pressure although further studies are warranted with a larger sample size, taking into account residual renal function and longer duration for impact on blood pressures.

MO843PREVALENCE AND MANAGEMENT OF HYPERTENSION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension (HTN) is common in hemodialysis (HD) patients &amp; diagnosed by pre-dialysis BP &amp;gt;140/90 mmHg. Causes include high salt intake, volume overload, &amp; loss of residual kidney function. Therapy includes achieving correct dry weight with each session, restricting interdialytic sodium &amp; fluid intake &amp; medications. We review its prevalence, factors associated with it &amp; its management in our patients. Method Demographics, HD prescription &amp; medications data collected for patients from 5 dialysis centers. Results A total of 1585 files reviewed. Males were 51.8% &amp; mean age was 59. Mean age significantly higher for females (61 vs 57). ESKD cause was DM in 51% &amp; HTN in 35%. However, of files reviewed, adequate data on comorbidities in 1390 patients (table 1), 69% had DM, 92% had HTN, 47% had CVD &amp; 31% had BMI &amp;gt; 25 (which was significantly more frequent in females). HTN was more likely in older patients, diabetics &amp; females with odds of HTN in females nearly twice the odds of HTN in males &amp; odds of HTN with DM is 2.27 times odds of HTN without DM &amp; one-year increase in age would increase odds of HTN by nearly 4%. Mean pre-HD BP for those with HTN was 143/76 mmHg &amp; for those without HTN was 136/75 mmHg. HD frequency was thrice weekly in 94% &amp; HD duration was &amp;gt; 3.5 hours in only 77% of patients. HDF used in 81.5%. Mean interdialytic weight gain (IDWG) was 2.8 kg, with no difference according to gender or presence of DM or HTN (Table 2). Higher IDWG associated with age &amp;lt; 65, Calcium bath of 1.75 &amp; Sodium bath &amp;gt; 138 with 0.638 kg higher IDWG with calcium of 1.75 compared to calcium of 1.25. Higher IDWG was associated with higher BP. Mean volume of fluid removed per session was 2.74, which was less than mean IDWG, with no difference according to gender or DM, however, it was higher in the higher dialysate sodium group, &amp; lower in the shorter session group (with trend towards statistical significance). CCB used to treat HTN in 62% followed by βB in 52%. Number of patients with HTN on 1 drug 21%, 2 drugs 27%, 3 drugs 23%, ≥ 4 drugs 20% &amp; 9% missing data. Number of antihypertensives did not correlate with IDWG. Conclusion Interdialytic weight gain in our HD patients is excessive &amp; contributing to HTN. Patients must restrict salt &amp; fluid intake &amp; dialysis centers must regularly &amp; frequently assess dry weight, ensure thrice weekly schedule &amp; 4 hours per session are met, so excess fluid is completely removed. Also, high sodium &amp; high calcium baths need to be avoided.

Consequences of Interdialytic Weight Gain Among Hemodialysis Patients.

BackgroundInterdialytic weight gain (IDWG) is a marker of higher pre-dialysis blood pressure, nutrition, and survival in hemodialysis (HD) patients. However, this relationship is incompletely characterized. In this study, we seek to define the association of IDWG/dry weight x100 (IDWG%) on blood pressure (BP), and the nutritional status of an HD population.Material and MethodsThis study was performed on 300 HD patients. The data was collected over four weeks, including total IDWG, IDWG%, and blood pressure. Normalized protein nitrogen appearance (nPNA), and serum albumin were used as markers of nutritional status. Participants were divided into three groups according to the mean of the IDWG% between two sessions of HD (group A < 3%, group B = 3% - 3.9%, and group C ≥ 4%); they were then compared on various aspects. Student t-test, analysis of variance (ANOVA), and linear regression analysis were used as statistical tools.ResultsThe mean (± standard deviation (SD)) age was 61.7 ± 14.2 years with 57.7% of the patients being male and 42.3% being female. The mean IDWG% for the whole studied population was 3.72% ± 1.73%. Between these three groups, a higher IDWG% was associated with younger males (p = 0.032), lower dry weight (p = 0.009), and longer duration on HD therapy (p = 0.009). IDWG% was directly associated with lower pre-dialysis serum sodium (p = 0.04), higher pre-dialysis serum creatinine (P = 0.002), and lower body mass index (BMI) (p= 0.003). Between these three groups, interdialytic variations in weight gain were not associated with increased BP. There was no significant difference between the three groups in terms of nPNA and serum albumin. ConclusionsThe most important associations of IDWG% are age, weight, pre-dialysis sodium, serum creatinine, and duration of dialysis (months). There was no association between IDWG% and increased systolic BP. IDWG% had no association with nutritional status.