Increasing Dialysis Sodium Removal on Arterial Stiffness and Left Ventricular Hypertrophy in Hemodialysis Patients.

Objective: The aim of the present study was to examine the effects of a mild increase in dialysis sodium removal on cardiovascular system in hypertensive hemodialysis (HD) patients.

Methods: Sixty four HD patients with pre-HD plasma sodium level higher than 138mmol/l, were randomly assigned into 2 groups. The dialysate sodium was reduced from 138mmol/l to 136mmol/l in the intervention group, while remained at 138mmol/l in the control group. During the study course, home systolic blood pressure (BP) target of 140mmHg was used in all patients, and bioimpedance measurements to guide ultrafiltration were performed monthly. 44-hour ambulatory BP, aortic pulse wave velocity (PWV), left ventricular mass index (LVMI), pre-HD plasma sodium concentration, interdialytic weight gain, and dietary sodium intake, were measured.

Results: Better BP control was achieved by 2 groups, with no significant differences. However, less annual averages of antihypertensives were used in the intervention group. The PWV values significantly decreased from 11.8±2.4 to 10.9±2.6m/s in the intervention group (P<0.001), and from 11.6±2.5 to 11.1±2.2m/s in the control group (P=0.012). LVMI regressed from 151±19 to 139±16 g/m2 (P<0.001) in the intervention group only. In addition, values for interdialytic weight gain and pre-HD plasma sodium decreased in the intervention group only. There were no significant differences in annual averages of dietary sodium intake and the frequency of adverse events between the 2 groups.

Conclusions: Increasing dialysis sodium removal was associated with improvements in arterial stiffness, left ventricular hypertrophy, and better BP control in hypertensive HD patients.