[Impact of two types of sodium and ultra filtration profiles on systolic and diastolic blood pressure in patients during hemodialysis]

ABSTRACT

Intradialytic hypotension is the most frequent complication in patients receiving haemodialysis [HD]. This complication not only contributes to the illness of the patients, but also decreases the efficacy of the HD. So, hypotension prevention is a major challenge for medical team, especially for nurses. One of the preventive methods that have recently been presented is the use of sodium profile and ultra filtration [UF] profile. The aim of this study was to compare the effects of linear sodium + UF profile [type1] with stepwise sodium + UF profile [type3] on systolic and diastolic blood pressure in HD patients. In this crossover design study, 26 HD patients from two dialysis centers at Esfahan University underwent three kinds of treatment [1] control, constant dialysate sodium concentration of 138 mmol/L with constant UF; [2] linear sodium profile + UF profile [type1], a linearly decreasing dialysate sodium concentration [146-138 mmol/L] in combination with a linearly decreasing UF rate; and [3] stepwise sodium profile + UF profile [type2], a stepwise decreasing dialysate sodium concentration [146-138 mmol/L] in combination with a stepwise decreasing UF rate. Eachtreatment was applied in three dialysis sessions. Data were analyzed using repeated measure ANOVA test in the SPSS. Twenty six patients participated in the study. A total of 234 dialysis sessions were analyzed. There were no significant differences in the systolic blood pressure between three groups during predialysis and first and the second hours [P>0.05]. The mean of systolic blood pressures were higher in the third hour and postdialysis during two types of profiles [1 and 3] compared with the routine care group [P<0.05]. The mean of diastolic blood pressure was also higher in postdialysis during two types of profiles [1 and 3] compared with the routine group [P<0.05]. There was no significant difference between the profiles 1and 3 [P>0.05]. In conclusion, sodium profile + UF profile is a simple and cost-effective method that modulate the dialysate sodium and ultra filtration rate and preserve the homodynamic status and blood pressure of patients during dialysis. Therefore, using sodium profile + UF profile [type1 and type 3] is recommended in order to prevent hypotension and reduce nursing work during hemodialysis process