INFLUENCE OF DAILY SODIUM INTAKE ON MORTALITY  IN  HD  PATIENTS

Galina Severova; Vlatko Karanfilovski; Ana Stojanovska- Severova; Lada Trajceska; Pavlina Dzekova- Vidimliski

Galina Severova University Clinic of Nephrology, Faculty of Medicine, Ss.Cyril and Methodius, University in Skopje, R. North Macedonia
Vlatko Karanfilovski University Clinic of Nephrology, Faculty of Medicine, Ss.Cyril and Methodius, University in Skopje, R. North Macedonia
Ana Stojanovska- Severova University Clinic of Nephrology, Faculty of Medicine, Ss.Cyril and Methodius, University in Skopje, R. North Macedonia
Lada Trajceska University Clinic of Nephrology, Faculty of Medicine, Ss.Cyril and Methodius, University in Skopje, R. North Macedonia
Pavlina Dzekova- Vidimliski University Clinic of Nephrology, Faculty of Medicine, Ss.Cyril and Methodius, University in Skopje, R. North Macedonia

Abstract

The aim of our study was to assess the influence of daily sodium intake (DSI) on the cardiovascular mortality in dialysis patients (pts). In prospective, observational study, 156 pts on hemodialysis (HD) were followed for 36 months,until death or kidney transplantation. Cardiovascular (CV) mortality was defined as death resulting from coronary heart disease, sudden death, stroke or complicated peripheral vascular disease and was notified from the patientsâ€™ medical history at baseline. Estimated DSI, as a major predictor for CV mortality, was calculated using formula European Best Practice Guidelines (EBPG) on Nutrition. In respect of median DSI (11.7 Â± 2.87 g/day) pts were stratified in two groups: Group 1 â€“ pts with low DSI (<11.7 g/day) and Group 2 â€“ patients with high DSI (> 11.7 g/day). The prevalence of CV comorbidities was not significantly different between two groups at baseline. At the end of the study, 41 pts (26.3%) died, among which 24 pts (60%) died from CV diseases. Kaplan-Mayer survival log rank test demonstrated that there was no difference in the cardiovascular survival between HD pts with high DSI and HD pts with low DSI(p>0.05).Serum levels of C-reactive protein (CRP) and mean age were significantly higher in pts diseased from CV disease compared to survived pts. Our results showed that HD pts may be particularly susceptible to non-osmotic sodium accumulation in skin and muscles. This study have shown that there was no significant influence of baseline DSI on the CV mortality of the pts included in the study.

Keywords: Dietary; mortality; renal dialysis; sodium chloride.

https://doi.org/10.55302/JMS2251054s

References

1. Nerbass FB, Calice-Silva V, Pecoits-Filho R. Sodium Intake and Blood Pressure in Patients with Chronic Kidney Disease: A Salty Relationship. Blood Purif. 2018;45(1-3):166-172.
2. Mc Causland FR, Waikar SS, Brunelli SM. The relevance of dietary sodium in hemodialysis. Nephrol Dial Transplant. 2013;28(4):797-802.
3. Mc Causland FR, Waikar SS, Brunelli SM. Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients. Kidney Int. 2012;82(2):204-211.
4. Rambod M, Tolouian R. Dietary sodium and clinical outcome in hemodialysis: where do we stand and what is next? Kidney Int. 2012 Jul;82(2):130-132.
5. Ahmad S. Dietary sodium restriction for hypertension in dialysis patients. Semin Dial. 2004 Jul-Aug;17(4):284-287.
6. Fouque D, Vennegoor M, Ter Wee P, WannerCh, Basci A, Canaud B et al. EBPG Guideline on Nutrition. Nephrology Dialysis Transplantation. Volume 22, Issue suppl_2, May 2007; pages ii45â€“ii87.
7. Ikenoue T, Koike K, Fukuma S, Ogata S, Iseki K, Fukuhara S. Salt Intake and All-Cause Mortality in Hemodialysis Patients. Am J Nephrol. 2018;48(2):87-95.
8. Dong J, Li Y, Yang Z, Luo J. Low dietary sodium intake increases the death risk in peritoneal dialysis. Clin J Am Soc Nephrol. 2010;5(2):240-247.
9. Heung AK, Sarnak MJ, Yan G, Berkoben M, Heyka R, Kaufman A et al. HEMO Study Group. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int. 2004 Jun;65(6):2380-2389.
10. Li H, Wang S. Cardiovascular Disease in Hemodialysis Patients. In: Suzuki H, editor. Hemodialysis [Internet]. London: IntechOpen; 2013 [cited 2022 Feb 08]. Available from: https://www.intechopen.com/chapters/42994 doi: 10.5772/53071.
11. Hecking M, Karaboyas A, Saran R, Sen A, HÃ¶rl WH, Pisoni RL et al. Predialysis serum sodium level, dialysate sodium, and mortality in maintenance hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2012 Feb;59(2):238-248.
12. Dahlmann A, DÃ¶rfelt K, Eicher F, Linz P, Kopp C, MÃ¶ssinger I et al. Magnetic resonance-determined sodium removal from tissue stores in hemodialysis patients. Kidney Int. 2015 Feb;87(2):434-441.
13. Kopp C, Linz P, Dahlmann A, Hammon M, Jantsch J, MÃ¼ller DNet al. 23Na magnetic resonance imaging-determined tissue sodium in healthy subjects and hypertensive patients. Hypertension. 2013 Mar;61(3):635-640.
14. Rossitto G, Mary S, Chen JY, Boder P, Chew KS, Neves KB, Alves RL, Montezano AC, Welsh P, Petrie MC, Graham D, Touyz RM, Delles C. Tissue sodium excess is not hypertonic and reflects extracellular volume expansion. Nat Commun. 2020 Aug 24;11(1):4222.
15. Titze J. Sodium balance is not just a renal affair. CurrOpinNephrolHypertens. 2014;23(2):101-105.
16. Jantsch J, Binger KJ, MÃ¼ller DN, Titze J. Macrophages in homeostatic immune function. Front Physiol. 2014 May 5;5:146.
17. Hofmeister LH, Perisic S, Titze J. Tissue sodium storage: evidence for kidney-like extrarenal countercurrent systems? Pflugers Arch. 2015 Mar;467(3):551-558.
18. Akdag S, Akyol A, Cakmak HA, Tosu AR, Asker M, Yaman M, et al. The effect of lowâ€sodium dialysate on ambulatory blood pressure measurement parameters in patients undergoing hemodialysis. Therapeutics & Clinical Risk Management 2015;11:1829â€1835.
19. Santos SF, Peixoto AJ. Sodium balance in maintenance hemodialysis. Semin Dial. 2010 Nov-Dec;23(6):549-555.