Effect of sodium and ultrafiltration profiling on hemodynamic stability, interdialytic weight gain, and intradialytic complications in hemodialysis patients

Background Hemodialysis is essential for end-stage renal disease but is frequently complicated by intradialytic hypotension (IDH), a multifactorial event linked to morbidity and mortality. This study aims to evaluate which sodium (Na) and ultrafiltration (UF) profiling methods best prevent IDH and related symptoms. Patients and methods This was a prospective, sequential intervention study (repeated-measures design) that evaluated the effects of various Na and UF profiling strategies on hemodynamic stability, interdialytic weight gain, and intradialytic complications in maintenance hemodialysis patients. Conducted over 17 weeks at Assiut University Hospital, 38 eligible patients underwent a control phase followed by randomized intervention phases with different Na and UF profiles. Clinical, laboratory, and machine-derived data were systematically collected and analyzed. Results The study compared three Na profiling strategies [linear (profile 1), stepwise (profile 2), and exponential profile 3)] applied either alone or in combination with UF profiling. Across interventions, dialysis adequacy improved progressively, with Kt/V rising from 0.91 in the control phase to 1.19 in the combined exponential Na+UF profile 3 ( P =0.012). While clearance remained stable, serum creatinine declined significantly from 9.2 mg/dl at baseline to ~7.7 mg/dl in intervention phases ( P =0.041). Hemodynamic stability notably improved, with the incidence of IDH decreasing from 23.7% in the control phase to 7.9% across intervention phases. Serum Na levels decreased in most intervention phases, but were best preserved using stepwise Na profiling (profile 2)+UF standard. Patient-reported well-being showed the most dramatic improvement with the combined linear Na and UF profile 1, rising from 13.2% in the control to 86.8% ( P <0.001). Conclusions Sodium and UF profiling significantly enhance dialysis adequacy and hemodynamic stability compared to standard dialysis. The optimal strategy identified was combined linear Na and UF profiling (Na profile 1+UF profile 1) (phase 3), which achieved the best balance of superior adequacy, hemodynamic stability, and patient well-being. For patients at high risk of IDH, combined exponential profiling (phase 7) eliminated hypotensive episodes. Conversely, isolated stepwise Na profiling (phase 4) is preferable for volume management but less effective for patient comfort. Therefore, we recommend individualized profiling specifically combined linear Na+UF (phase 3) over standard fixed settings for routine maintenance hemodialysis.