Effect of dialysate sodium profiling and gradient ultrafiltration on hypotension

Objective This study aimed to investigate the effects of dialysate sodium profiling and gradient ultrafiltration on hypotension during hemodialysis. Methods In this study, a single‐blinded, crossover design of 4 different dialysis protocols was undertaken. Four hemodialysis protocols were administered to 40 patients to 2 mounts (12 hemodialysis sessions). A total of 40 patients experiencing hypotension episodes during hemodialysis and who agreed to participate were included in the study. All patients were administered 4 different hemodialysis protocols consecutively. Protocol 1 = linear sodium dialysate 1 (Na: 150 mEq/L and decreased by 4 mEq/L at each hour) and constant ultrafiltration; Protocol 2 = linear sodium dialysate and gradient ultrafiltration; Protocol 3 = constant sodium dialysate and gradient ultrafiltration; and Protocol 4 (standard hemodialysis) = constant sodium dialysate and constant ultrafiltration. Results The results of this study show that when linear sodium dialysate and gradient ultrafiltration are used concomitantly, hypotension episodes decrease, more ultrafiltration is performed, and less treatment is needed. Gradient sodium dialysate usage (Protocol 1 and 2) required fewer treatment interventions for hypotension compared to standard protocol. No significant differences were observed between standard hemodialysis and any of the other protocols after dialysis for plasma osmolarity. Conclusion We recommend concomitant use of gradient ultrafiltration and sodium dialysate in patients with hypotension.