Effect of Dialysate Sodium Concentration on Sodium Gradient and Hemodialysis Parameters

This retrospective study was performed to determine the ranges of the sodium gradient (SG) between the dialysate sodium concentration (DNa) and serum sodium concentration (SNa) in hemodialysis (HD) patients and to examine the relationships between HD parameters over a 1 year period. Fifty-five clinically stable HD patients, who had been on HD >2 years were enrolled. Monthly HD [ultrafiltration (UF) amount, systolic blood pressure (SBP), frequency of intradialytic hypotension (IDH)] and laboratory data were collected and 12-month means were subjected to analysis. The SG was calculated by subtracting SNa from prescribed DNa. Mean SG values were 1.5±3.3 (range -5.6~9.1). SG was positively related to DNa and the frequency of IDH. A higher SG was associated with larger UF amounts and SBP reduction during HD. The percentages of patients with a SG ≥3mEq/L increased as DNa increased. On the other hand, SG was not found to be associated with SNa or pre-HD SBP. DNa appears to cause a significant increase in SG, and this seems to be related to HD parameters, such as, UF amount and IDH.