الفهرس 
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Abstract
Conventional hemodialysis remains the most common treatment for
end-stage renal disease (ESRD) worldwide and is usually performed for 3
to 5 hours, 3 days per week. It is estimated that up to one-third of patients
on conventional hemodialysis and peritoneal dialysis are volume
overloaded. Intradialytic weight gain (IDWG) is often used as a surrogate
marker for fluid overload and studies have shown that a higher IDWG%
predicts cardiovascular events.
Several mechanisms have been proposed to explain how volume
overload leads to increased mortality in the dialysis population, mostly
linking volume overload to left ventricular hypertrophy with associated
cardiovascular events and more recently, to inflammation which in turn
leads to accelerated atherosclerosis. Higher UF rates and IDWG may also
lead to more frequent episodes of intradialytic hypotension, which occurs
in 10% to 30% of treatments, ranges from asymptomatic episodes to
marked compromise of organ perfusion resulting in myocardial ischemia,
cardiac arrhythmias, vascular thrombosis, loss of consciousness, seizures,
or death. But approximately 5–15 % of chronic HD patients have a
paradoxical rise in BP during the HD session.
Recent studies have shown that the potential benefits of using higher
dialysate sodium with regard to hemodynamic stability are outweighed by
increased thirst, higher IDWG, and higher pre-dialysis blood pressure.
Furthermore, frequently used sodium modeling algorithms which
typically involve tapering a high dialysate sodium concentration during
hemodialysis can lead to greater IDWG and higher pre-dialysis blood
pressure. The optimal dialysate sodium concentration, however, still remains
unclear. Many dialysis centers around the world use a standard dialysate
sodium concentration for all patients; a recent DOPPS report showed that
57% of hemodialysis facilities use a standard dialysate sodium
prescription.
However, multiple studies have suggested that each dialysis patient
may have a unique osmolar set point for plasma sodium and, therefore,
dialysate sodium needs to be individualized.
More recently, there has been growing evidence that the sodium
gradient is important to minimize in hemodialysis patients as it positively
correlates with changes in BP during hemodialysis and IDWG.
This study aimed to study the value of dialysis sodium gradient as a
modifiable risk factor for fluid overload in hemodialysis patients.
This study was conducted on 102 hemodialysis patients regularly
coming for hemodialysis unit in Zefta general hospital, Al Gharbia
governorate, Egypt. Patients were classified according to blood pressure
variability into three groups: group I: consisted of 56 patients with No
blood pressure variability, group II: consisted of 24 patients who had
Intradialytic hypotension and group III: consisted of 22 patients who had
Intradialytic hypertension.
Our results show there were no statistically significant differences
between the studied groups as regard gender (p=0.1939), age (p=0.192),
primary renal dieses (p=0.189) and vascular access type (p=0.978),
dialysis duration (p=0.976), hemoglobin (p=0.131), pre, post-dialytic urea
(p=0.839, p=0.120), pre, post-dialytic creatinine (p=0.584, p=0.190),
differences between Post-dialytic urea and pre-dialytic urea (P= 0.729),
differences between Post-dialytic creatinine and pre-dialytic creatinine
(P=0.974), ultrafiltration (UF) rate (p=0.729), UF volume (p=0.698) and
IDWG% (p=0.777) and Sodium gradient (p=0.468). Our results show there was a positive correlation between sodium
gradient and the mean IDWG %, mean UF volume and rate among the
studied hemodialysis patients.
Conclusion:
Based on our results we can concluded that there was appositive
correlation between sodium gradient and IDWG% and consequently UF
volume and UF rate.
A higher sodium gradient was associated with significant increases
in IDWG and UF rates, known to be associated with poor outcomes.
Individualizing the dialysate sodium prescription to minimize sodium gap
may lead to less fluid overload in conventional hemodialysis patients.