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Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study

Journal of Human Hypertension (2024)Cite this article

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Abstract

Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibit an increased cardiovascular risk compared to hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. In a randomized cross-over manner, 29 IDH patients underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice versa. 48 h ambulatory BP measurement was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48 h, 24 h, day-time and night-time periods were calculated. Mean 48 h BP was 5.3/2.6 mmHg lower with low compared to standard dialysate sodium concentration, (p = 0.005/p = 0.007 respectively). All 48 h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg, p = 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p = 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p = 0.392; SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p = 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some comparisons with a trend for lower BPV during day-time 2 and higher BVP during night-time 2 with low dialysate sodium. In conclusion, low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should explore alternative interventions to reduce BP and BPV in this high-risk population.

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Fig. 1: Differences between low and standard dialysate sodium in 48-h SBP and DBP variability indices.

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Access to trial data can be made available to researchers upon reasonable request to the corresponding author.

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Authors and Affiliations

  1. First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Fotini Iatridi, Eleni Karkamani, Marieta P. Theodorakopoulou, Nikolaos Devrikis, Aikaterini Papagianni & Pantelis Sarafidis

  2. Department of Nephrology, University Clinical Centre Maribor, Maribor, Slovenia

    Robert Ekart

  3. Frontis Dialysis Center, Athens, Greece

    Efstathios Xagas & Ioanna Revela

  4. Therapeutiki Hemodialysis Unit, Thessaloniki, Greece

    Antonios Karpetas

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  1. Fotini Iatridi
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  2. Robert Ekart
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Contributions

Research idea and study design: Fotini Iatridi, Pantelis Sarafidis; data acquisition: Fotini Iatridi, Efstathios Xagas, Robert Ekart, Antonios Karpetas, Ioanna Revela, Marieta Theodorakopoulou, Eleni Karkamani, Nikolaos Devrikis; data analysis/interpretation: Fotini Iatridi, Pantelis Sarafidis; statistical analysis: Fotini Iatridi; manuscript drafting: Fotini Iatridi, Pantelis Sarafidis; supervision or mentorship: Aikaterini Papagianni, Pantelis Sarafidis.

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Correspondence to Fotini Iatridi.

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The study protocol was approved by the Ethics Committee of the School of Medicine, Aristotle University of Thessaloniki (Approval Number 4555).

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Iatridi, F., Ekart, R., Xagas, E. et al. Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study. J Hum Hypertens (2024). https://doi.org/10.1038/s41371-024-00947-w

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