nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2020-3-346-357nid-217Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВыбор уровня натрия в диализирующем растворе в достижении целей оптимального диализа: одноцентровое пилотное исследованиеThe choice of sodium dialysate level in achieving of optimal hemodialysis targets: literature review and pilot studyМатвееваД. А.MatveevaD. A.noemail@neicon.ruГерасимчукР. П.GerasimchukR. P.noemail@neicon.ruСабодашА. Б.SabodashA. B.noemail@neicon.ruЗемченковА. Ю.ZemchenkovA. Yu.kletk@inbox.ruБакулинИ. Г.BakulinI. G.noemail@neicon.ruСПбГБУЗ «Городская Мариинская больница»РоссияCity Mariinsky HospitalRussian FederationСПбГБУЗ «Городская Мариинская больница»; ФГБОУ ВО «Северо-Западный ГМУ им. И.И. Мечникова» Минздрава РоссииРоссияCity Mariinsky Hospital; North-Western State medical university named after I.I. MechnikovRussian FederationФГБОУ ВО «Первый СПб ГМУ им. акад. И.П. Павлова» Минздрава России; ББраун Авитум Руссланд Клиникс, ОП1РоссияPavlov First Saint Petersburg State medical university; BBraun Avitum Russland Clinics, Unit 1Russian FederationСПбГБУЗ «Городская Мариинская больница»; ФГБОУ ВО «Северо-Западный ГМУ им. И.И. Мечникова» Минздрава России; ФГБОУ ВО «Первый СПб ГМУ им. акад. И.П. Павлова» Минздрава РоссииРоссияCity Mariinsky Hospital; North-Western State medical university named after I.I. Mechnikov; Pavlov First Saint Petersburg State medical universityRussian FederationФГБОУ ВО «Северо-Западный ГМУ им. И.И. Мечникова» Минздрава РоссииРоссияNorth-Western State medical university named after I.I. MechnikovRussian Federation202029072024223346357Copyright © Матвеева Д.А., Герасимчук Р.П., Сабодаш А.Б., Земченков А.Ю., Бакулин И.Г., 20242024Матвеева Д.А., Герасимчук Р.П., Сабодаш А.Б., Земченков А.Ю., Бакулин И.Г.Matveeva D.A., Gerasimchuk R.P., Sabodash A.B., Zemchenkov A.Y., Bakulin I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/217

Предпосылки и цели. Низкий уровень натрия в диализате (NaD) снижает междиализную прибавку веса (МДПВ) и АД, что связывают с улучшением результатов. Но вмешательство также увеличивает интрадиализную гипотензию (ИДГ) и снижает содержание натрия в сыворотке (NaS), что связано с повышенным риском смертности, поэтому NaD следует индивидуализировать и приблизить к NaS. Предиализная натриемия у ГД-пациентов считается постоянной, но некоторые наблюдения противоречат этому утверждению. Методы. Среди 45 пациентов с ГД в течение 24 месяцев ежемесячно фиксировали данные: NaS, NaD, МДПВ, интрадиализная гипер- и гипотензия, судороги, пери- и интрадиализное АД, оценки АД дома, предполагаемый сухой вес, UF, частота/продолжительность ГД. Результаты. У 45 пациентов в возрасте 60 (34÷83) лет, средний срок ГД 63 (29÷93) месяцев, средняя натриемия из 1048 проб составила 137,1±2,8 ммоль/л. Внутрииндивидуальное среднее значение NaS варьировало 132-141 ммоль/л, медиана CV 1,4%. Тенденция к снижению NaD (-0,12 ммоль/л/год) сопровождалась более заметными тенденциями в отношении систолического АД (-3,3 ммHg/год) и диастолического АД (-1,6 ммHg/год); ИДГ учащалась на 1,6 эпизода/100ГД/год (2,3±0,6 после исключения тренда). 73% не имели значимой индивидуальной тенденции в NaS (<1 ммоль/л/год), 18% пациентов имели тенденцию к снижению NaS (-1,5 ммоль/л/год); 9% - к увеличению (+1,6 ммоль/л/год). Внутрииндивидуальные вариации NaS не имели связи со средним NaS и средним градиентом по натрию (NaG). Мы наблюдали значительные различия в NaS только у пациентов с большим колебанием массы тела до диализа. Общее среднее NaG было минимально положительным (+0,15±3,0 ммоль/л), но 58% пациентов имели отрицательный или нейтральный NaG. Последние имели меньшую МДПВ, но частота ИДГ не различалась. Мы оценили количество последовательных ежемесячных преддиализных NaS, необходимую для приемлемой оценки среднего двухлетнего преддиализного NaS: пять значений дали 96% попадания в диапазон ±1%. Вывод. Натрий сыворотки стабилен в течение долгого времени у ГД пациентов, за исключением пациентов с большими внутрииндивидуальными вариациями веса до диализа, и может использоваться для индивидуализации NaD.

Background and Aims. The low dialysate sodium (NaD) reduces intradialytic weight gain (IDWG) and BP, which are associated with improved outcomes. However, the intervention also increases intradialytic hypotension (IDH) and reduces serum sodium (NaS), that are associated with increased mortality risk, so NaD should be individualized and brought closer to NaS. Predialysis NaS in HD-patients is considered constant but some observations contradict this statement. Method. Among 45 HD patients we monitored the following parameters: NaS, NaD, IDWG, intradialysis hyper- and hypotension and seizures, peri- and intradialysis blood pressure (BP), home BP estimated, estimated dry weight, UF, and HD frequency/duration for 24 months. Results. In 45 patients of 60 (34÷83) years old, median HD vintage 63 (29÷93) months the average NaS in 1048 probes was 137.1±2.8 mmol/l. Intra-individual NaS mean varied 132-141 mmol/l, CV median was 1.4%. The decreasing NaD trend (-0.12 mmol/l/year) was accompanied by more prominent trends in systolic BP (-3.3 mm Hg/year) and diastolic BP (-1.6 mm Hg/year); the IDH increased by 1.6 episodes/100HD/year (2.3±0.6 after excluding the trend). 73% of patients had no significant individual trend in NaS (<1 mmol/l/year), 18% had decreasing trend (-1.5 mmol/l/year); 9% - increasing trend (mean +1.6 mmol/l per year). Intraindividual variations in NaS had no link with mean NaS or mean NaS to dialysate gradient (NaG). We observed a significant variations in NaS only in patients with large variations of predialysis weight. Overall mean NaG was slightly positive (+0.15±3.0 mmol/l) while 58% of patients had negative or neutral NaG. The latter had lesser IDWG but no difference in IDH frequency. We evaluated the number of consecutive monthly predialysis NaS need to get acceptable estimation of mean two-year predialysis NaS: five values gave 96% hit in range ±1%. Conclusion. Serum sodium is stable over time in HD patients with the only exception of patients with large intraindividual predialysis weight variation and may be used for individualizing NaD.

гемодиализустановочная точка по натриюградиент по натриюинтрадиализные осложненияhemodialysissodium set-pointsodium gradientintradialytic complicationsReferencesScribner BH, Buri R, Caner JE et al. The treatment of chronic uremia by means of intermittent hemodialysis: a preliminary report. Trans Am Soc Artif Intern Organs. 1960;6:114-122.Scribner BH, Buri R, Caner JE et al. The treatment of chronic uremia by means of intermittent hemodialysis: a preliminary report. Trans Am Soc Artif Intern Organs. 1960;6:114-122.Manera KE, Tong A, Craig JC et al. An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis. Kidney Int. 2019;96(3):699-710. doi: 10.1016/j.kint.2019.03.015.Manera KE, Tong A, Craig JC et al. An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis. Kidney Int. 2019;96(3):699-710. doi: 10.1016/j.kint.2019.03.015.Steyaert S, Holvoet E, Nagler E et al. Reporting of "dialysis adequacy" as an outcome in randomised trials conducted in adults on haemodialysis. PLoS One. 2019;14(2):e0207045. doi: 10.1371/journal.pone.0207045.Steyaert S, Holvoet E, Nagler E et al. Reporting of "dialysis adequacy" as an outcome in randomised trials conducted in adults on haemodialysis. PLoS One. 2019;14(2):e0207045. doi: 10.1371/journal.pone.0207045.Vanholder R, Glorieux G, Eloot S. Once upon a time in dialysis: the last days of Kt/V? Kidney Int. 2015;88(3):460-5. doi: 10.1038/ki.2015.155.Vanholder R, Glorieux G, Eloot S. Once upon a time in dialysis: the last days of Kt/V? Kidney Int. 2015;88(3):460-5. doi: 10.1038/ki.2015.155.Chan CT, Blankestijn PJ, Dember LM et al. Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;96(1):37-47. doi: 10.1016/j.kint.2019.01.017.Chan CT, Blankestijn PJ, Dember LM et al. Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;96(1):37-47. doi: 10.1016/j.kint.2019.01.017.Румянцев АШ, Земченков ГА, Сабодаш АБ. К вопросу о перспективах обновления клинических рекомендаций по гемодиализу. Нефрология 2019; 23 (2): 49-76.Румянцев АШ, Земченков ГА, Сабодаш АБ. К вопросу о перспективах обновления клинических рекомендаций по гемодиализу. Нефрология 2019; 23 (2): 49-76.Flythe JE, Bansal N. The relationship of volume overload and its control to hypertension in hemodialysis patients. Semin Dial. 2019;32(6):500-506. doi: 10.1111/sdi.12838.Flythe JE, Bansal N. The relationship of volume overload and its control to hypertension in hemodialysis patients. Semin Dial. 2019;32(6):500-506. doi: 10.1111/sdi.12838.Marshall MR, Chan CT. The Evolution of Home HD - Meeting Modern Patient Needs. Contrib Nephrol. 2017;189:36-45. doi: 10.1159/000450820Marshall MR, Chan CT. The Evolution of Home HD - Meeting Modern Patient Needs. Contrib Nephrol. 2017;189:36-45. doi: 10.1159/000450820Dasgupta I, Thomas GN, Clarke J et al. Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes. Clin J Am Soc Nephrol. 2019;14(3):385-393. doi: 10.2215/CJN.08240718.Dasgupta I, Thomas GN, Clarke J et al. Associations between Hemodialysis Facility Practices to Manage Fluid Volume and Intradialytic Hypotension and Patient Outcomes. Clin J Am Soc Nephrol. 2019;14(3):385-393. doi: 10.2215/CJN.08240718.Tangvoraphonkchai K, Davenport A. Why does the choice of dialysate sodium concentration remain controversial? Hemodial Int. 2018;22(4):435-444. doi: 10.1111/hdi.12645.Tangvoraphonkchai K, Davenport A. Why does the choice of dialysate sodium concentration remain controversial? Hemodial Int. 2018;22(4):435-444. doi: 10.1111/hdi.12645.Bansal N, McCulloch CE, Rahman M, CRIC Study Investigators. Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis: the chronic renal insufficiency cohort study. Hypertension. 2015;65(1):93-100. doi: 10.1161/HYPERTENSIONAHA.114.04334.Bansal N, McCulloch CE, Rahman M, CRIC Study Investigators. Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis: the chronic renal insufficiency cohort study. Hypertension. 2015;65(1):93-100. doi: 10.1161/HYPERTENSIONAHA.114.04334.Weiner DE, Brunelli SM, Hunt A et al. Improving clinical outcomes among hemodialysis patients: a proposal for a "volume first" approach from the chief medical officers of US dialysis providers. Am J Kidney Dis. 2014;64:685-695. DOI: 10.1053/j.ajkd.2014.07.003Weiner DE, Brunelli SM, Hunt A et al. Improving clinical outcomes among hemodialysis patients: a proposal for a "volume first" approach from the chief medical officers of US dialysis providers. Am J Kidney Dis. 2014;64:685-695. DOI: 10.1053/j.ajkd.2014.07.003Hecking M, Moissl U, Genser B et al. Greater fluid overload and lower interdialytic weight gain are independently associated with mortality in a large international hemodialysis population. Nephrol Dial Transplant. 2018;33(10):1832-1842. doi: 10.1093/ndt/gfy083.Hecking M, Moissl U, Genser B et al. Greater fluid overload and lower interdialytic weight gain are independently associated with mortality in a large international hemodialysis population. Nephrol Dial Transplant. 2018;33(10):1832-1842. doi: 10.1093/ndt/gfy083.Zoccali C, Moissl U, Chazot C et al. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017;28(8):2491-2497. doi: 10.1681/ASN.2016121341.Zoccali C, Moissl U, Chazot C et al. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017;28(8):2491-2497. doi: 10.1681/ASN.2016121341.Kotanko P, Garg AX, Depner T et al. Effects of frequent hemodialysis on blood pressure: results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015;19(3):386-401. doi: 10.1111/hdi.12255.Kotanko P, Garg AX, Depner T et al. Effects of frequent hemodialysis on blood pressure: results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015;19(3):386-401. doi: 10.1111/hdi.12255.Земченков АЮ, Герасимчук РП. Результаты перевода пациентов на четырехразовый гемодиализ. Нефрология и диализ. 2019. 21(1): 32-39.Земченков АЮ, Герасимчук РП. Результаты перевода пациентов на четырехразовый гемодиализ. Нефрология и диализ. 2019. 21(1): 32-39.Banshodani M, Kawanishi H, Moriishi M et al. Impact of hybrid therapy comprising peritoneal dialysis and hemodialysis on acute cardiovascular events. Blood Purif. 2019;47(4):330-336. doi: 10.1159/000495357.Banshodani M, Kawanishi H, Moriishi M et al. Impact of hybrid therapy comprising peritoneal dialysis and hemodialysis on acute cardiovascular events. Blood Purif. 2019;47(4):330-336. doi: 10.1159/000495357.Flythe JE, Kshirsagar AV, Falk RJ, Brunelli SM. Associations of Posthemodialysis Weights above and below Target Weight with All-Cause and Cardiovascular Mortality. Clin J Am Soc Nephrol. 2015;10(5):808-16. doi: 10.2215/CJN.10201014.Flythe JE, Kshirsagar AV, Falk RJ, Brunelli SM. Associations of Posthemodialysis Weights above and below Target Weight with All-Cause and Cardiovascular Mortality. Clin J Am Soc Nephrol. 2015;10(5):808-16. doi: 10.2215/CJN.10201014.Tangvoraphonkchai K, Davenport A. Extracellular water excess and increased self-reported fatigue in chronic hemodialysis patients. Ther Apher Dial. 2018;22(2):152-159. doi: 10.1111/1744-9987.12648.Tangvoraphonkchai K, Davenport A. Extracellular water excess and increased self-reported fatigue in chronic hemodialysis patients. Ther Apher Dial. 2018;22(2):152-159. doi: 10.1111/1744-9987.12648.Hussein WF, Arramreddy R, Sun SJ et al. Higher ultrafiltration rate is associated with longer dialysis recovery time in patients undergoing conventional hemodialysis. Am J Nephrol. 2017;46:3-10. doi:10.1159/000476076Hussein WF, Arramreddy R, Sun SJ et al. Higher ultrafiltration rate is associated with longer dialysis recovery time in patients undergoing conventional hemodialysis. Am J Nephrol. 2017;46:3-10. doi:10.1159/000476076Cabrera C, Brunelli SM, Rosenbaum D et al. A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients. BMC Nephrol. 2015;16:113. doi: 10.1186/s12882-015-0110-9.Cabrera C, Brunelli SM, Rosenbaum D et al. A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients. BMC Nephrol. 2015;16:113. doi: 10.1186/s12882-015-0110-9.Colson A, Brinkley A, Braconnier P et al. Impact of salt reduction in meals consumed during hemodialysis sessions on interdialytic weight gain and hemodynamic stability. Hemodial Int. 2018;22(4):501-506. doi: 10.1111/hdi.12655Colson A, Brinkley A, Braconnier P et al. Impact of salt reduction in meals consumed during hemodialysis sessions on interdialytic weight gain and hemodynamic stability. Hemodial Int. 2018;22(4):501-506. doi: 10.1111/hdi.12655Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol. 2017;18(1):318. doi: 10.1186/s12882-017-0734-z.Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol. 2017;18(1):318. doi: 10.1186/s12882-017-0734-z.Santos SF, Peixoto AJ, Perazella MA. How should we manage adverse intradialytic blood pressure changes? Adv Chronic Kidney Dis. 2012;19:158-165. doi: 10.1053/j.ackd.2012.03.003.Santos SF, Peixoto AJ, Perazella MA. How should we manage adverse intradialytic blood pressure changes? Adv Chronic Kidney Dis. 2012;19:158-165. doi: 10.1053/j.ackd.2012.03.003.Agarwal R. How can we prevent intradialytic hypotension? Curr Opin Nephrol Hypertens. 2012;21:593-599.Agarwal R. How can we prevent intradialytic hypotension? Curr Opin Nephrol Hypertens. 2012;21:593-599.Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clinical J Am Soc Nephrol. 2009;4:914-920. DOI: 10.2215/CJN.03900808Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clinical J Am Soc Nephrol. 2009;4:914-920. DOI: 10.2215/CJN.03900808Hecking M, Karaboyas A, Antlanger M et al. Significance of interdialytic weight gain versus chronic volume overload: consensus opinion. Am J Nephrol. 2013;38:78-90. doi:10.1159/000353104Hecking M, Karaboyas A, Antlanger M et al. Significance of interdialytic weight gain versus chronic volume overload: consensus opinion. Am J Nephrol. 2013;38:78-90. doi:10.1159/000353104Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250-7. doi: 10.1038/ki.2010.383.Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250-7. doi: 10.1038/ki.2010.383.Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients. Am J Kidney Dis. 2016;68(6):911-922. doi: 10.1053/j.ajkd.2016.06.020.Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients. Am J Kidney Dis. 2016;68(6):911-922. doi: 10.1053/j.ajkd.2016.06.020.McIntyre CW, Burton JO, Selby NM et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008;3(1):19-26. doi: 10.2215/CJN.03170707.McIntyre CW, Burton JO, Selby NM et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008;3(1):19-26. doi: 10.2215/CJN.03170707.MacEwen C, Sutherland S, Daly J et al. Relationship between Hypotension and Cerebral Ischemia during Hemodialysis. J Am Soc Nephrol. 2017;28(8):2511-2520. doi: 10.1681/ASN.2016060704.MacEwen C, Sutherland S, Daly J et al. Relationship between Hypotension and Cerebral Ischemia during Hemodialysis. J Am Soc Nephrol. 2017;28(8):2511-2520. doi: 10.1681/ASN.2016060704.Seong EY, Zheng Y, Winkelmayer WC et al. The relationship between intradialytic hypotension and hospitalized mesenteric ischemia: a case-control study. Clin J Am Soc Nephrol. 2018;13:1517-1525.Seong EY, Zheng Y, Winkelmayer WC et al. The relationship between intradialytic hypotension and hospitalized mesenteric ischemia: a case-control study. Clin J Am Soc Nephrol. 2018;13:1517-1525.McIntyre CW, Harrison LE, Eldehni MT et al. Circulating endotoxemia: a novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(1):133-41. doi: 10.2215/CJN.04610510.McIntyre CW, Harrison LE, Eldehni MT et al. Circulating endotoxemia: a novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(1):133-41. doi: 10.2215/CJN.04610510.Chang TI, Paik J, Greene T et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol. 2011;22(8):1526-33. doi: 10.1681/ASN.2010101119.Chang TI, Paik J, Greene T et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol. 2011;22(8):1526-33. doi: 10.1681/ASN.2010101119.Beaubien-Souligny W, Kontar L, Blum D et al. Meta-Analysis of Randomized Controlled Trials Using Tool-Assisted Target Weight Adjustments in Chronic Dialysis Patients. Kidney Int Rep. 2019;4(10):1426-1434. doi: 10.1016/j.ekir.2019.07.003.Beaubien-Souligny W, Kontar L, Blum D et al. Meta-Analysis of Randomized Controlled Trials Using Tool-Assisted Target Weight Adjustments in Chronic Dialysis Patients. Kidney Int Rep. 2019;4(10):1426-1434. doi: 10.1016/j.ekir.2019.07.003.Reddan DN, Szczech LA, Hasselblad V et al. Intradialytic blood volume monitoring in ambulatory hemodialysis patients: a randomized trial.J Am Soc Nephrol. 2005;16(7):2162-2169. DOI: 10.1681/ASN.2004121053Reddan DN, Szczech LA, Hasselblad V et al. Intradialytic blood volume monitoring in ambulatory hemodialysis patients: a randomized trial.J Am Soc Nephrol. 2005;16(7):2162-2169. DOI: 10.1681/ASN.2004121053Hara T, Kimachi M, Ikenoue T et al. Intra-Dialytic Hemoglobin Changes and Cardiovascular Events: A Cohort Study on Dialysis Outcomes and Practice Patterns in Japan. Am J Nephrol. 2019;50(4):272-280. doi: 10.1159/000502633.Hara T, Kimachi M, Ikenoue T et al. Intra-Dialytic Hemoglobin Changes and Cardiovascular Events: A Cohort Study on Dialysis Outcomes and Practice Patterns in Japan. Am J Nephrol. 2019;50(4):272-280. doi: 10.1159/000502633.Nishiwaki H, Hasegawa T, Koiwa F et al. The association of the difference in hemoglobin levels before and after hemodialysis with the risk of 1-year mortality in patients undergoing hemodialysis. Results from a nationwide cohort study of the Japanese Renal Data Registry. PLoS One. 2019;14(1):e0210533. doi:10.1371/journal.pone.0210533Nishiwaki H, Hasegawa T, Koiwa F et al. The association of the difference in hemoglobin levels before and after hemodialysis with the risk of 1-year mortality in patients undergoing hemodialysis. Results from a nationwide cohort study of the Japanese Renal Data Registry. PLoS One. 2019;14(1):e0210533. doi:10.1371/journal.pone.0210533Loutradis C, Sarafidis PA, Ekart R et al. The effect of dry-weight reduction guided by lung ultrasound on ambulatory blood pressure in hemodialysis patients: a randomized controlled trial. Kidney Int. 2019;95(6):1505-1513. doi: 10.1016/j.kint.2019.02.018.Loutradis C, Sarafidis PA, Ekart R et al. The effect of dry-weight reduction guided by lung ultrasound on ambulatory blood pressure in hemodialysis patients: a randomized controlled trial. Kidney Int. 2019;95(6):1505-1513. doi: 10.1016/j.kint.2019.02.018.Вишневский КА, Герасимчук РП, Земченков АЮ. Коррекция «сухого веса» у больных, получающих лечение программным гемодиализом по результатам векторного анализа биоимпеданса. Нефрология. 2014; 18(2):61-71.Вишневский КА, Герасимчук РП, Земченков АЮ. Коррекция «сухого веса» у больных, получающих лечение программным гемодиализом по результатам векторного анализа биоимпеданса. Нефрология. 2014; 18(2):61-71.Lambie SH, Taal MW, Fluck RJ, McIntyre CW. Online conductivity monitoring: validation and usefulness in a clinical trial of reduced dialysate conductivity. ASAIO J. 2005;51(1):70-6.Lambie SH, Taal MW, Fluck RJ, McIntyre CW. Online conductivity monitoring: validation and usefulness in a clinical trial of reduced dialysate conductivity. ASAIO J. 2005;51(1):70-6.Manlucu J, Gallo K, Heidenheim PA, Lindsay RM. Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system. Am J Kidney Dis. 2010;56(1):69-76. doi: 10.1053/j.ajkd.2009.12.037.Manlucu J, Gallo K, Heidenheim PA, Lindsay RM. Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system. Am J Kidney Dis. 2010;56(1):69-76. doi: 10.1053/j.ajkd.2009.12.037.Akyol A, Akdag S, Asker M et al. Effects of lowered dialysate sodium on left ventricle function and brain natriuretic peptide in maintenance of hemodialysis patients. Hum Exp Toxicol. 2016;36:128-134. doi: 10.1177/0960327116639362.Akyol A, Akdag S, Asker M et al. Effects of lowered dialysate sodium on left ventricle function and brain natriuretic peptide in maintenance of hemodialysis patients. Hum Exp Toxicol. 2016;36:128-134. doi: 10.1177/0960327116639362.Liu J, Sun F, Ma LJ, Shen Y, Mei X, Zhou YL. Increasing dialysis sodium removal on arterial stiffness and left ventricular hypertrophy in hemodialysis patients. J Ren Nutr. 2016;26:38-44. doi: 10.1053/j.jrn.2015.08.005.Liu J, Sun F, Ma LJ, Shen Y, Mei X, Zhou YL. Increasing dialysis sodium removal on arterial stiffness and left ventricular hypertrophy in hemodialysis patients. J Ren Nutr. 2016;26:38-44. doi: 10.1053/j.jrn.2015.08.005.Gumrukcuoglu HA, Ari E, Akyol A, et al. Effects of lowering dialysate sodium on carotid artery atherosclerosis and endothelial dysfunction in maintenance hemodialysis patients. Int Urol Nephrol. 2012;44:1833-1839. doi: 10.1007/s11255-011-0117-5.Gumrukcuoglu HA, Ari E, Akyol A, et al. Effects of lowering dialysate sodium on carotid artery atherosclerosis and endothelial dysfunction in maintenance hemodialysis patients. Int Urol Nephrol. 2012;44:1833-1839. doi: 10.1007/s11255-011-0117-5.Aybal Kutlugun A, Erdem Y, Okutucu S et al. Effects of lowering dialysate sodium on flow-mediated dilatation in patients with chronic kidney disease. Nephrol Dial Transpl. 2011;26:3678-3682. doi: 10.1093/ndt/gfr092.Aybal Kutlugun A, Erdem Y, Okutucu S et al. Effects of lowering dialysate sodium on flow-mediated dilatation in patients with chronic kidney disease. Nephrol Dial Transpl. 2011;26:3678-3682. doi: 10.1093/ndt/gfr092.Tugman MJ, Narendra JH, Li Q et al. Ultrafiltration-profiled hemodialysis to reduce dialysis-related cardiovascular stress: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun. 2019;15:100415. doi: 10.1016/j.conctc.2019.100415.Tugman MJ, Narendra JH, Li Q et al. Ultrafiltration-profiled hemodialysis to reduce dialysis-related cardiovascular stress: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun. 2019;15:100415. doi: 10.1016/j.conctc.2019.100415.Dunlop JL, Vandal AC, Marshall MR. Low dialysate sodium levels for chronic haemodialysis. Cochrane Database of Systematic Reviews 2019;1(1):CD011204. Published 2019 Jan 16. doi:10.1002/14651858.CD011204.pub2Dunlop JL, Vandal AC, Marshall MR. Low dialysate sodium levels for chronic haemodialysis. Cochrane Database of Systematic Reviews 2019;1(1):CD011204. Published 2019 Jan 16. doi:10.1002/14651858.CD011204.pub2Сабодаш АБ, Салихова КА, Земченков ГА и соавт. Динамика артериальной гипертензии и выживаемость у пациентов на гемодиализе. Нефрология и диализ. 2016; 18(4):416-430.Сабодаш АБ, Салихова КА, Земченков ГА и соавт. Динамика артериальной гипертензии и выживаемость у пациентов на гемодиализе. Нефрология и диализ. 2016; 18(4):416-430.Dekker M, Konings C, Canaud B et al. Pre-dialysis fluid status, pre-dialysis systolic blood pressure and outcome in prevalent haemodialysis patients: results of an international cohort study on behalf of the MONDO initiative. Nephrol Dial Transplant. 2018;33(11):2027-2034. doi: 10.1093/ndt/gfy095.Dekker M, Konings C, Canaud B et al. Pre-dialysis fluid status, pre-dialysis systolic blood pressure and outcome in prevalent haemodialysis patients: results of an international cohort study on behalf of the MONDO initiative. Nephrol Dial Transplant. 2018;33(11):2027-2034. doi: 10.1093/ndt/gfy095.Zwiech R, Bruzda-Zwiech A. The dual blockade of the renin-angiotensin system in hemodialysis patients requires decreased dialysate sodium concentration. Int Urol Nephrol. 2013;45(5):1365-72. doi: 10.1007/s11255-012-0320-z.Zwiech R, Bruzda-Zwiech A. The dual blockade of the renin-angiotensin system in hemodialysis patients requires decreased dialysate sodium concentration. Int Urol Nephrol. 2013;45(5):1365-72. doi: 10.1007/s11255-012-0320-z.Peixoto A, Gorda M, Parikh C, Santos S. Long-term stability of serum sodium in hemodialysis patients. Blood Purif 2010;29(3):264-7. doi: 10.1159/000274460.Peixoto A, Gorda M, Parikh C, Santos S. Long-term stability of serum sodium in hemodialysis patients. Blood Purif 2010;29(3):264-7. doi: 10.1159/000274460.Basile C, Libutti P, Lisi P et al. Sodium setpoint and gradient in bicarbonate hemodialysis. J Nephrol 2012 26 (6), 1136-42. doi: 10.5301/jn.5000236Basile C, Libutti P, Lisi P et al. Sodium setpoint and gradient in bicarbonate hemodialysis. J Nephrol 2012 26 (6), 1136-42. doi: 10.5301/jn.5000236Albalate Ramón M, de Sequera Ortiz P, Pérez-García R et al. Sodium set-point in haemodialysis: is it what we see clinically? Nefrologia. 2013;33(6):808-815. doi:10.3265/Nefrologia.pre2013.Sep.12117Albalate Ramón M, de Sequera Ortiz P, Pérez-García R et al. Sodium set-point in haemodialysis: is it what we see clinically? Nefrologia. 2013;33(6):808-815. doi:10.3265/Nefrologia.pre2013.Sep.12117Gul A, Miskulin DC, Paine SS et al. Comparison of Prescribed and Measured Dialysate Sodium: A Quality Improvement Project. Am J Kidney Dis. 2016;67(3):439-445. doi:10.1053/j.ajkd.2015.11.004Gul A, Miskulin DC, Paine SS et al. Comparison of Prescribed and Measured Dialysate Sodium: A Quality Improvement Project. Am J Kidney Dis. 2016;67(3):439-445. doi:10.1053/j.ajkd.2015.11.004Marshall MR, Vandal AC, de Zoysa JR et al. Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial [published online ahead of print, 2020 Mar 18]. J Am Soc Nephrol. 2020;ASN.2019090877. doi:10.1681/ASN.2019090877Marshall MR, Vandal AC, de Zoysa JR et al. Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial [published online ahead of print, 2020 Mar 18]. J Am Soc Nephrol. 2020;ASN.2019090877. doi:10.1681/ASN.2019090877de Paula FM, Peixoto AJ, Pinto LV et al. Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int. 2004;66(3):1232-8. DOI: 10.1111/j.1523-1755.2004.00876.xde Paula FM, Peixoto AJ, Pinto LV et al. Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int. 2004;66(3):1232-8. DOI: 10.1111/j.1523-1755.2004.00876.xKim DY, Kim B, Moon KH et al. Effect of gradually lowering dialysate sodium concentration on the interdialytic weight gain, blood pressure, and extracellular water in anuric hemodialysis patients. Ren Fail. 2014;36(1):23-27. doi:10.3109/0886022X.2013.830360Kim DY, Kim B, Moon KH et al. Effect of gradually lowering dialysate sodium concentration on the interdialytic weight gain, blood pressure, and extracellular water in anuric hemodialysis patients. Ren Fail. 2014;36(1):23-27. doi:10.3109/0886022X.2013.830360Arramreddy R, Sun SJ, Munoz Mendoza J et al. Individualized reduction in dialysate sodium in conventional in-center hemodialysis. Hemodial Int. 2012;16(4):473-480. doi:10.1111/j.1542-4758.2012.00701.xArramreddy R, Sun SJ, Munoz Mendoza J et al. Individualized reduction in dialysate sodium in conventional in-center hemodialysis. Hemodial Int. 2012;16(4):473-480. doi:10.1111/j.1542-4758.2012.00701.xJung ES, Lee J, Lee JW et al. Increasing the dialysate sodium concentration based on serum sodium concentrations exacerbates weight gain and thirst in hemodialysis patients. Tohoku J Exp Med. 2013;230(2):117-121. doi:10.1620/tjem.230.117Jung ES, Lee J, Lee JW et al. Increasing the dialysate sodium concentration based on serum sodium concentrations exacerbates weight gain and thirst in hemodialysis patients. Tohoku J Exp Med. 2013;230(2):117-121. doi:10.1620/tjem.230.117Macunluoglu B, Gumrukcuoglu HA, Atakan A et al. Lowering dialysate sodium improves systemic oxidative stress in maintenance hemodialysis patients. Int Urol Nephrol. 2016;48(10):1699-1704. doi:10.1007/s11255-016-1367-zMacunluoglu B, Gumrukcuoglu HA, Atakan A et al. Lowering dialysate sodium improves systemic oxidative stress in maintenance hemodialysis patients. Int Urol Nephrol. 2016;48(10):1699-1704. doi:10.1007/s11255-016-1367-zRaimann JG, Ficociello LH, Usvyat LA et al. Effects of dialysate to serum sodium (Na+) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project. BMC Nephrol. 2018;19(1):75. doi:10.1186/s12882-018-0870-0Raimann JG, Ficociello LH, Usvyat LA et al. Effects of dialysate to serum sodium (Na+) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project. BMC Nephrol. 2018;19(1):75. doi:10.1186/s12882-018-0870-0Ságová M, Wojke R, Maierhofer A et al. Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis. Artif Organs. 2019;43(10):1002-1013. doi:10.1111/aor.13463Ságová M, Wojke R, Maierhofer A et al. Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis. Artif Organs. 2019;43(10):1002-1013. doi:10.1111/aor.13463

The authors declare that there are no conflicts of interest present.