SODIUM MODELING AMELIORATES INTRADIALYTIC AND INTERDIALYTIC SYMPTOMS IN YOUNG HEMODIALYSIS-PATIENTS

Despite advances in the delivery of hemodialysis, significant dialytic morbidity persists. Sodium modeling in older adults has been shown to decrease some dialytic symptoms, but clear benefits in young patients without coexisting diabetes or advanced cardiovascular disease have n ot been shown. The effects of sodium modeling were evaluated in 16 ado lescent and young adult hemodialysis patients (16 to 32 yr of age) tre ated with conventional hemodialysis for a median of 11.5 months. The 8 -wk study was divided into four 2-wk blocks. During each block, one of three sodium programs or a constant (control) dialysate sodium of 138 mEq/L was used. During each sodium program, the initial dialysate sod ium of 148 mEq/L was decreased by an exponential, linear, or step prog ram to 138 mEq/L. Treatments with sodium modeling were significantly b etter than those with constant sodium dialysate. When all sodium progr ams were grouped and compared with constant dialysate sodium, the odds of improvement in dialytic cramps, headaches, and nausea were 1.8, 2. 1, and 3.9, respectively (P < 0.05). Sodium modeling also significantl y decreased the frequency of postdialysis hypotension and interdialyti c fatigue, dizziness, and muscle cramping (P < 0.05). No differences w ere seen among the sodium protocols in the incidence of symptomatic hy potension, the amount of normal saline administered, the degree of hem oconcentration during treatments, or the decrease in serum osmolality. There was no increase in pretreatment or posttreatment serum sodium c oncentrations, interdialytic thirst, weight gain, or hypertension. Sod ium modeling dramatically decreases both intradialytic and interdialyt ic morbidity in young hemodialysis patients. There was no increase in adverse events associated with sodium modeling.