The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
(2009) In Nephrology Dialysis Transplantation 24(5). p.1609-1617- Abstract
- Background. Poor ultrafiltration is associated with worse outcomes in peritoneal dialysis (PD) patients. This might in part reflect problems associated with salt and water excess. Increasing the diffusive component of peritoneal sodium removal using low-sodium PD fluids might have beneficial effects on blood pressure (BP), thirst and fluid status that could translate into clinical benefits. Methods. Using a multicentre, prospective, baseline controlled (1 month), non-randomized intervention (2 months) design, two novel solutions designed from predictions using the three-pore model were investigated. In group A ([Na+] = 115 mmol/l), the glucose (G) was increased to 2.0% to compensate for reduced osmolality whereas in group B ([Na+] = 102... (More)
- Background. Poor ultrafiltration is associated with worse outcomes in peritoneal dialysis (PD) patients. This might in part reflect problems associated with salt and water excess. Increasing the diffusive component of peritoneal sodium removal using low-sodium PD fluids might have beneficial effects on blood pressure (BP), thirst and fluid status that could translate into clinical benefits. Methods. Using a multicentre, prospective, baseline controlled (1 month), non-randomized intervention (2 months) design, two novel solutions designed from predictions using the three-pore model were investigated. In group A ([Na+] = 115 mmol/l), the glucose (G) was increased to 2.0% to compensate for reduced osmolality whereas in group B ([Na+] = 102 mmol/l), it was unchanged (2.5%). Both solutions were substituted for one 3- to 5-h exchange per day and no change was made to the rest of the dialysis regime. Results. Ten patients in group A and 15 in group B completed the study. Both solutions resulted in significant increases (30-50 mmol/dwell) in diffusive sodium removal during the test exchanges, P < 0.001. Ultrafiltration was maintained in group A but reduced in group B. Ambulatory nocturnal mean BP fell in group A [93.1 +/- 10.6 mmHg (+/- SD) versus 85.1 +/- 10.2 mmHg, P < 0.05], but was stable in group B (95.4 +/- 9.4 versus 95.1.1 +/- 10.7 mmHg, NS). Thirst reduced independent of appetite and mood in both groups by 2 months, more markedly in group A. Indices of fluid status, including TBW by bioimpedance and D dilution also improved in group A, P < 0.05, whereas weight increased in group B. Conclusions. Increasing the diffusive component of sodium removal whilst maintaining ultrafiltration is associated with improvements in BP, thirst and fluid status. The lack of effect seen with uncompensated low-sodium dialysate suggests that these benefits cannot be achieved by manipulation of dialysate sodium removal alone. These observations provide valuable information of the design of future randomized studies to establish the clinical role for low-sodium dialysis fluids. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1399470
- author
- Davies, Simon ; Carlsson, Ola ; Simonsen, Ole LU ; Johansson, Ann-Cathrine LU ; Venturoli, Daniele LU ; Ledebo, Ingrid ; Wieslander, Anders ; Chan, Cian and Rippe, Bengt LU
- organization
- publishing date
- 2009
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- thirst, fluid status, deuterium, bioimpedance, blood pressure
- in
- Nephrology Dialysis Transplantation
- volume
- 24
- issue
- 5
- pages
- 1609 - 1617
- publisher
- Oxford University Press
- external identifiers
-
- wos:000265275000043
- scopus:65249181541
- pmid:19145002
- ISSN
- 1460-2385
- DOI
- 10.1093/ndt/gfn668
- language
- English
- LU publication?
- yes
- additional info
- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Department of Nephrology (013230024), Emergency medicine/Medicine/Surgery (013240200)
- id
- 54a06622-937c-4c6a-9f9c-8cfc3bfcd7f2 (old id 1399470)
- date added to LUP
- 2016-04-01 14:06:12
- date last changed
- 2022-03-14 03:39:05
@article{54a06622-937c-4c6a-9f9c-8cfc3bfcd7f2,
abstract = {{Background. Poor ultrafiltration is associated with worse outcomes in peritoneal dialysis (PD) patients. This might in part reflect problems associated with salt and water excess. Increasing the diffusive component of peritoneal sodium removal using low-sodium PD fluids might have beneficial effects on blood pressure (BP), thirst and fluid status that could translate into clinical benefits. Methods. Using a multicentre, prospective, baseline controlled (1 month), non-randomized intervention (2 months) design, two novel solutions designed from predictions using the three-pore model were investigated. In group A ([Na+] = 115 mmol/l), the glucose (G) was increased to 2.0% to compensate for reduced osmolality whereas in group B ([Na+] = 102 mmol/l), it was unchanged (2.5%). Both solutions were substituted for one 3- to 5-h exchange per day and no change was made to the rest of the dialysis regime. Results. Ten patients in group A and 15 in group B completed the study. Both solutions resulted in significant increases (30-50 mmol/dwell) in diffusive sodium removal during the test exchanges, P < 0.001. Ultrafiltration was maintained in group A but reduced in group B. Ambulatory nocturnal mean BP fell in group A [93.1 +/- 10.6 mmHg (+/- SD) versus 85.1 +/- 10.2 mmHg, P < 0.05], but was stable in group B (95.4 +/- 9.4 versus 95.1.1 +/- 10.7 mmHg, NS). Thirst reduced independent of appetite and mood in both groups by 2 months, more markedly in group A. Indices of fluid status, including TBW by bioimpedance and D dilution also improved in group A, P < 0.05, whereas weight increased in group B. Conclusions. Increasing the diffusive component of sodium removal whilst maintaining ultrafiltration is associated with improvements in BP, thirst and fluid status. The lack of effect seen with uncompensated low-sodium dialysate suggests that these benefits cannot be achieved by manipulation of dialysate sodium removal alone. These observations provide valuable information of the design of future randomized studies to establish the clinical role for low-sodium dialysis fluids.}},
author = {{Davies, Simon and Carlsson, Ola and Simonsen, Ole and Johansson, Ann-Cathrine and Venturoli, Daniele and Ledebo, Ingrid and Wieslander, Anders and Chan, Cian and Rippe, Bengt}},
issn = {{1460-2385}},
keywords = {{thirst; fluid status; deuterium; bioimpedance; blood pressure}},
language = {{eng}},
number = {{5}},
pages = {{1609--1617}},
publisher = {{Oxford University Press}},
series = {{Nephrology Dialysis Transplantation}},
title = {{The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status}},
url = {{http://dx.doi.org/10.1093/ndt/gfn668}},
doi = {{10.1093/ndt/gfn668}},
volume = {{24}},
year = {{2009}},
}