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The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status

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...

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Autores principales: Davies, Simon, Carlsson, Ola, Simonsen, Ole, Johansson, Ann-Cathrine, Venturoli, Daniele, Ledebo, Ingrid, Wieslander, Anders, Chan, Cian, Rippe, Bengt
Formato: Texto
Lenguaje:English
Publicado: Oxford University Press 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668964/
https://www.ncbi.nlm.nih.gov/pubmed/19145002
http://dx.doi.org/10.1093/ndt/gfn668
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author Davies, Simon
Carlsson, Ola
Simonsen, Ole
Johansson, Ann-Cathrine
Venturoli, Daniele
Ledebo, Ingrid
Wieslander, Anders
Chan, Cian
Rippe, Bengt
author_facet Davies, Simon
Carlsson, Ola
Simonsen, Ole
Johansson, Ann-Cathrine
Venturoli, Daniele
Ledebo, Ingrid
Wieslander, Anders
Chan, Cian
Rippe, Bengt
author_sort Davies, Simon
collection PubMed
description 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.
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spelling pubmed-26689642009-04-20 The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status Davies, Simon Carlsson, Ola Simonsen, Ole Johansson, Ann-Cathrine Venturoli, Daniele Ledebo, Ingrid Wieslander, Anders Chan, Cian Rippe, Bengt Nephrol Dial Transplant Dialysis 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. Oxford University Press 2009-05 2009-01-14 /pmc/articles/PMC2668964/ /pubmed/19145002 http://dx.doi.org/10.1093/ndt/gfn668 Text en © The Author [2009]. http://creativecommons.org/licenses/by-nc/2.0/uk/ The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
spellingShingle Dialysis
Davies, Simon
Carlsson, Ola
Simonsen, Ole
Johansson, Ann-Cathrine
Venturoli, Daniele
Ledebo, Ingrid
Wieslander, Anders
Chan, Cian
Rippe, Bengt
The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
title The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
title_full The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
title_fullStr The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
title_full_unstemmed The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
title_short The effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
title_sort effects of low-sodium peritoneal dialysis fluids on blood pressure, thirst and volume status
topic Dialysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668964/
https://www.ncbi.nlm.nih.gov/pubmed/19145002
http://dx.doi.org/10.1093/ndt/gfn668
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