Impact of sodium and ultrafiltration profiling on hemodialysis-related symptoms

Dialysate sodium and ultrafiltration profiling are two methods to reduce sy mptoms during hemodialysis. The objective of the study was to determine the efficacy of combining these techniques to reduce symptoms in chronic hemod ialysis patients. Blood volume changes were measured to determine whether a ny benefit of profiling could be explained through this mechanism. Patients were randomized to profiled dialysate sodium and ultrafiltration or consta nt dialysate sodium and ultrafiltration. The study was a two-period, two-tr eatment, crossover design with repeated measures. The primary outcome was h ypotension and/or symptomatic events observed by the dialysis nurse. Second ary outcomes were symptom survey scores, weights, BP, and blood volume chan ges. Thirty-three patients were randomized. On standard treatment, 30.6% of dialysis sessions were symptomatic compared with 20.4% on profiled treatme nts. The odds ratio for development of hypotension or symptomatic event on profiled treatments was 0.61 (95% confidence interval, 0.39 to 0.96) compar ed with standard treatment. Patients had lower symptom scores by questionna ire in both the intradialytic and the interdialytic periods during profiled treatments. Predialysis weight was greater during profiled treatments by 0 .3 kg (P = 0.008), but there were no differences in postdialysis weight, BP , or thirst. There was no difference in maximum decrease in blood volume du ring the two treatments (standard, -11.2% profiled, -10.0%; P = 0.08), but there was a significant difference in the rate of change in blood volume (s tandard, -2.96%/h; profiled, -1.96%/h; P < 0.001). Decrease in blood volume , rate of change in blood volume, and predialysis weights were not associat ed with hypotension or symptomatic dialysis sessions. In conclusion, dialys ate sodium and ultrafiltration profiling significantly reduces hemodialysis -related symptoms. Profiling reduces the slope of the blood volume curve du ring dialysis, but blood volume changes are not predictive of symptomatic e vents for an individual patient.