Effect of Individualized Dialysate Sodium for maintenance hemodialysis patients in tertiary hospital

Dialysate, i.e. fluid which is used for dialysis has sodium as an important constituent. The level of dialysate sodium determines various aspects of the dialysis session such as blood pressure, thirst after dialysis and the weight gain between two dialysis sessions. Currently,all patients undergoing dialysis worldwideare dialyzed with dialysate sodium which is arbitrarily set, irrespective oftheir blood sodium levels. A dialysatesodium concentration higher than the patient’s own blood sodium level can contribute to increased thirst, weight gain in between the dialysis and increasein blood pressure. Using individualized dialysate sodium is thought to avoid addition of excess sodium and water to the patient’s body.

In this study we aim to study the effect of individualizing the dialysate sodium (near to the patient’s blood sodium levels) on weight gain between two dialysis sessions, blood pressure before dialysis, requirement of blood-pressure-lowering medications and also on the blood pressure during dialysis.

We are randomizing the participants based on a fixed protocol to either receive individialized dialysate sodium (2 mEq above patient’s own blood sodium levels) or to receive standard dialysate sodium of 136 mEq/L- which is current standard of care. After 1 month, the patient will switch the groups and will receive the other group’s sodium level in the dialysis fluid. The monitoring will be done to see weight gains between two dialysis sessions in both groups.

As a close monitoring is always done during the hemodialysis session, risk to the participants is less. All fluctuations in blood pressure in both arms of the study will be dealt with using standard protocols.