Is there any role for sodium modeling in the prevention of intradialytic hypotension in patients with large interdialytic fluid gains?

摘要

Large weight gains between dialysis sessions are a vexing problem in dialysis patients. A commonly recognized complication of large interdialytic weight gains (IDWG) is intradialytic hypotension (IDH) (1,2), a problem that is both frequent and disabling. While sodium modeling has been shown to be effective in preventing IDH acutely (3), the longer-term use of sodium modeling is not ideal because of cumulative positive sodium balance in patients. This brief report addresses the use of sodium modeling for patients with IDH and large IDWG. Intradialytic hypotension is often defined as at least a 20 mmHg decrease in either the systolic or mean arterial blood pressure in combination with clinical symptoms requiring intervention (4,5). In one recent series, 15% of patients experienced at least one episode of hypotension in the course of three treatments, while 2% of patients had an episode of IDH in each of the three treatments (6). Large IDWG have consistently been shown to be a risk factor for IDH (1,2) and are also associated with increased blood pressure (7,8) and higher mortality (9,10).