Key result
Low dialysate sodium cuts interdialytic weight gain by ~0.4 kg versus standard or high sodium.
Why the study?
The study was conducted to evaluate the effect of low dialysate sodium concentration on interdialytic weight gain in chronic hemodialysis patients.
Does low dialysate sodium concentration reduce interdialytic weight gain in adult patients on chronic hemodialysis?
Systematic Review (n=710)
Does low dialysate sodium concentration reduce interdialytic weight gain in adult patients on chronic hemodialysis?
Effect estimate: MD -0.40 kg (95% CI -0.50 to -0.30)
p-value: p=<0.001
Using a low dialysate sodium concentration (<138 mmol/l) significantly reduces interdialytic weight gain in patients on chronic hemodialysis, which may help mitigate fluid overload.
May mitigate fluid overload risk in hemodialysis; reinforces pooled trial evidence for low dialysate sodium.
PURPOSE: The present systematic review and meta-analysis aimed at evaluating the effect of low dialysate sodium concentration on interdialytic weight gain (IDWG) in chronic hemodialysis patients. METHODS: Studies were eligible for inclusion if they were English language papers published in a peer-reviewed journal and met the following inclusion criteria: (1) studies in adult patients (over 18 years of age), (2) included patients on chronic hemodialysis since at least 6 months; (3) compared standard (138-140 mmol/l) or high (> 140 mmol/l) dialysate sodium concentration with low (< 138 mmol/l) dialysate sodium concentration; (4) Included one outcome of interest: interdialytic weight gain. Medline, PubMed, Web of Science, and the Cochrane Library were searched for the quality of reporting for each study was performed using the Quality Assessment Tool of Controlled Intervention Studies of the National Institutes of Health. The quality of reporting of each cross-over study was performed using the Revised Cochrane Risk of Bias (RoB) tool for cross-over trials as proposed by Ding et al. RESULTS: Nineteen studies (710 patients) were included in the analysis: 15 were cross-over and 4 parallel randomized controlled studies. In cross-over studies, pooled analysis revealed that dialysate sodium concentration reduced IDWG with a pooled MD of - 0.40 kg (95% CI - 0.50 to - 0.30; p < 0.001). The systematic review of four parallel, randomized, studies revealed that the use of a low dialysate sodium concentration was associated with a significant reduction of the IDWG in two studies, sustained and almost significant (p = 0.05) reduction in one study, and not significant reduction in one study. CONCLUSION: Low dialysate sodium concentration reduces the IDWG in prevalent patients on chronic hemodialysis.
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Bossola et al. (2024) conducted a systematic review in Chronic hemodialysis (n=710). Low dialysate sodium concentration vs. Standard (138-140 mmol/l) or high (>140 mmol/l) dialysate sodium concentration was evaluated on Interdialytic weight gain (IDWG) (MD -0.40 kg, 95% CI -0.50 to -0.30, p=<0.001). Low dialysate sodium concentration significantly reduced interdialytic weight gain with a pooled mean difference of -0.40 kg compared to standard or high sodium concentration in patients on chronic hemodialysis.
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