The effect of succinate-containing dialysis solution on the symptoms of CKD C5d stage

BACKGROUND . Attempts to improve the clinical outcomes of hemodialysis (HD) treatment through interventions aimed at improving quantitative indicators of uremia correction are not effective enough. The guidelines of professionals for different treatment outcomes differ from the interests and preferences of patients. THE AIM: to evaluate the possibilities of improving symptoms in HD patients by changing the composition of dialysis solution from standard to succinate-containing (SCDS). PATIENTS AND METHODS . The cohort study included 137 patients from one dialysis center. Symptoms were assessed by the Dialysis Symptom Index (DSI). RESULTS . Initially, the median score on the questionnaire was 21 [13.25–37.75], after a year – 25.0 [14.0–38.7]; the median of individual dynamics did not differ from 0 (0,0 [-4,7–9,0], p=0.407). At the same time, the dynamics of DSI in the group of those transferred to SCDS differed from that in the stable mode group: -1 (-12-5.75) vs. 3.5 (-2.25–16.5): Z=-2.714; p=0.007. In a one-factor logistic analysis, switching to SCDS reduced the risk of worsening the symptoms of whole DSI by 75.9 %: OR 0.241 (0.099-0.587); p=0.002, as well as for the mental and bodily components (OR 0.296 (0.123-0.709, p=0.006) and 0.389 (0.163-0.927, p=0.033), respectively). In the multifactorial logistic analysis model, significant factors were: the fact of conversion to SCDS, higher levels of albumin (-5 % risk per 0.1 mmol/l), hemoglobin (-41 % risk per 10 g/l), as well as a higher ultrafiltration rate (+17 % per 1 ml/hour/kg) and a higher phosphate level (+ 8 % per 0.1 mmol/l). CONCLUSION . The use of a succinate-containing dialysis solution in comparison with the standard one can improve the dynamics of DSI. Additional significant factors related to the dynamics of symptoms are the initial levels of albumin, hemoglobin, phosphates in the blood, and the rate of ultrafiltration.