#2260 Should dialysate sodium be routinely prescribed to patients with chronic haemodialysis?

Abstract Background and Aims Chronic hemodialysis patients often experience fluid and electrolyte imbalances, including hyponatremia, which can has been linked to increased mortality, morbidity, and poor quality of life. Since patients' individual hypothalamic sodium (Na) set point is variable, the dialysate Na concentration also contribute to above mentioned outcomes a large extent. Dialyzing patients with standard dialysate solutions can lead to Na transfer in individuals with low Na set points. This study aims to investigate the relationship between serum Na (sNa) level, interdialytic weight gain (IDWG), and predialysis arterial pressure in chronic hemodialysis patients. Method This was a retroprospective cohort study conducted at 6 hemodialysis units. We included adult patients who had been on maintenance hemodialysis for at least 3 months. Patients with active infection, current malignancy, adrenal insufficiency, untreated hypothyroidism and uncontrolled diabetes, advanced congestive heart failure, advanced chronic liver disease, or use of centrally acting drugs associated with hyponatremia were excluded. Demographic and clinical data, as well as, laboratory values were collected from electronic medical records, including predialysis sNa levels corrected due to glucose, as an average value of the last 3 months. Patients were categorized into two groups based on their mean predialysis sNa levels: those with lower (≤137 mEq/L) and those with higher (>137 mEq/L) Na. Comparisons were made between the groups using one-way ANOVA and chi-square tests as appropriate. These patients were then observed for 1 year for incremental dialysis need and mortality outcomes. Patients who died within 1 year were compared to those who survived in terms of their predialysis Na levels, IDWG, and predialysis blood pressure. Correlation analysis were performed to determine the associations between independent variables. Results A total of 176 patients were included, with a mean age of 58.1 ± 15.2 years and 50% were male. The mean predialysis sNa level was 138.8 ± 2.6 mEq/L (Table 1). Patients in the lower Na group (n = 49) had higher IDWG compared to the higher Na group (n = 127), but did not reach statistical significance (4.92 vs 4.46 kg, P = 0.565). Predialysis systolic blood pressure was significantly higher in the lower Na group compared to the higher group (130.8 vs 138.9 mmHg, P = 0.032). A negative correlation was found between predialysis systolic blood pressure and sNa level (r = −0.213, P = 0.005), while a positive correlation was found between the number of antihypertensive medications used (r = 0.207, P = 0.006). Positive and significant correlations were found between IDWG and hemodialysis vintage (r = 0.210, P = 0.005), as well as, between IDWG and the need for increased dialysis (130.8 vs 138.9 mmHg, P = 0.032). The one-year mortality rate did not show any significant differences between the groups due to sNa levels. Conclusion The study reveals that lower sNa levels in chronic hemodialysis patients are associated with higher predialysis systolic blood pressure. Therefore, closely monitoring sNa levels and customizing dialysate Na concentrations may help optimize hemodynamic stability and reduce complications in this patient population.