The impact of low Sodium dialysate on different echocardiographic parameters in prevalent hemodialysis patients

Abstract

Cardiovascular disease (CVD) remains the major cause of death in end-stage renal disease (ESRD) patients, with a mortality rate approximately 10 to 30 times greater than that of the general population. Chronic fluid overload is a frequent problem in patients treated by hemodialysis; and it is known to be associated with different clinical conditions like hypertension, increased arterial stiffness, left ventricular hypertrophy, heart failure and consequently higher morbidity and mortality. Patients with advanced CRF are particularly sensitive to sodium load. Hypertension appears even with a relatively low normal sodium intake. This peculiar sensitivity to sodium load increases as CRF progresses. In renal failure and hemodialysis (HD), the patients who cannot restrict sodium in their diets develop a significant saline excess between dialyses. The dialysate sodium concentration is an important issue for sodium overload. If there is a diffusive removal of sodium, as occurs with low dialysate sodium concentrations, the excess sodium removal over water removal causes a decrease in extracellular sodium concentration. A high dialysate sodium concentration may improve hemodynamic