Skip to main content
SpringerLink
Log in

Lowering dialysate sodium improves systemic oxidative stress in maintenance hemodialysis patients

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the current prospective study was to evaluate the effects of low sodium dialysate on oxidative stress parameters, blood pressure (BP) and endothelial dysfunction in maintenance hemodialysis (HD) patients.

Methods

After baseline measurements were taken, the dialysate sodium concentration was reduced from 140 to 137 mEq/L. Oxidative stress parameters and flow-mediated dilatation (FMD %) were measured before and after 6 months of HD with low sodium dialysate. Interdialytic weight gain (IDWG) and pre- and post-dialysis BP were monitored during the study.

Results

A total of 52 patients were enrolled and 41 patients completed the study. There was a significant reduction in systolic blood pressure at the end of the study [130.00 (90.00–190.00) vs. 120.00 (90.00–150.00), p < 0.001]. Similarly, there were significant improvements in IDWG [2670.00 (1670.00–4300.00) vs. 1986.00 (1099.00–3998.00), p < 0.001] and FMD % [7.26 (4.55–8.56) vs. 9.56 (6.55–12.05), p < 0.001]. Serum MDA levels (p < 0.001) were significantly decreased; serum SOD (p < 0.001) and GPx (p < 0.001) activities were significantly increased after low sodium HD compared to standard sodium HD.

Conclusion

Our data seem to suggest a potential role of 137 mEq/L sodium dialysate for improving hemodynamic status, endothelial function and reducing oxidative stress than 140 mEq/L sodium dialysate in maintenance HD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ma KW, Greene EL, Raij L (1992) Cardiovascular risk factors in chronic renal failure and hemodialysis populations. Am J Kidney Dis 19(6):505–513

    Article  CAS  PubMed  Google Scholar 

  2. Dursun B, Dursun E, Suleymanlar G et al (2008) Carotid artery intima-media thickness correlates with oxidative stress in chronic haemodialysis patients with accelerated atherosclerosis. Nephrol Dial Transplant 23(5):1697–1703

    Article  PubMed  Google Scholar 

  3. Menon V, Gul A, Sarnak MJ (2005) Cardiovascular risk factors in chronic kidney disease. Kidney Int 68(4):1413–1418

    Article  PubMed  Google Scholar 

  4. Zoccali C, Mallamaci F, Tripepi G (2003) Traditional and emerging cardiovascular risk factors in end-stage renal disease. Kidney Int Suppl 85:105–110

    Article  Google Scholar 

  5. Vaziri ND (2004) Oxidative stress in uremia: nature, mechanisms, and potential consequences. Semin Nephrol 24(5):469–473

    Article  CAS  PubMed  Google Scholar 

  6. Ward RA, McLeish KR (2003) Oxidant stress in hemodialysis patients: What are the determining factors? Artif Organs 27(3):230–236

    Article  CAS  PubMed  Google Scholar 

  7. Bossola M, Tazza L (2015) Wishful thinking: the suprisingly sparse evidence for a relationship between oxidative stress and cardiovascular disease in hemodialysis patients. Semin Dial 28(3):224–230

    Article  PubMed  Google Scholar 

  8. Morris ST, McMurray JJ, Rodger RS, Jardine AG (2000) Impaired endothelium-dependent vasodilatation in uraemia. Nephrol Dial Transplant 15(8):1194–1200

    Article  CAS  PubMed  Google Scholar 

  9. Morris ST, McMurray JJ, Spiers A, Jardine AG (2001) Impaired endothelial function in isolated human uremic resistance arteries. Kidney Int 60(3):1077–1082

    Article  CAS  PubMed  Google Scholar 

  10. Kari JA, Donald AE, Vallance DT et al (1997) Physiology and biochemistry of endothelial function in children with chronic renal failure. Kidney Int 52(2):468–472

    Article  CAS  PubMed  Google Scholar 

  11. Dishy V, Sofowora GG, Imamura H et al (2003) Nitric oxide production decreases after salt loading but is not related to blood pressure changes or nitric oxide-mediated vascular responses. J Hypertens 21(1):153–157

    Article  CAS  PubMed  Google Scholar 

  12. Matrougui K, Schiavi P, Guez D, Henrion D (1998) High sodium intake decreases pressure-induced (myogenic) tone and flow-induced dilation in resistance arteries from hypertensive rats. Hypertension 32(1):176–179

    Article  CAS  PubMed  Google Scholar 

  13. Van Stone JC, Bauer J, Carey J (1982) The effect of dialysate sodium concentration on body fluid compartment volume, plasma renin activity and plasma aldosterone concentration in chronic hemodialysis patients. Am J Kidney Dis 2(1):58–64

    Article  PubMed  Google Scholar 

  14. Gumrukcuoglu HA, Ari E, Akyol A et al (2012) Effects of lowering dialysate sodium on carotid artery atherosclerosis and endothelial dysfunction in maintenance hemodialysis patients. Int Urol Nephrol 44(6):1833–1839

    Article  CAS  PubMed  Google Scholar 

  15. Kaya Y, Ari E, Demir H et al (2012) Accelerated atherosclerosis in haemodialysis patients; correlation of endothelial function with oxidative DNA damage. Nephrol Dial Transplant 27(3):1164–1169

    Article  CAS  PubMed  Google Scholar 

  16. Kutlugün AA, Erdem Y, Okutucu S et al (2011) Effects of lowering dialysate sodium on flow-mediated dilatation in patients with chronic kidney disease. Nephrol Dial Transplant 26(11):3678–3682

    Article  Google Scholar 

  17. Khoschsorur GA, Winklhofer-Roob BM, Rabl H et al (2000) Evaluation of a sensitive HPLC method for determination of malondialdehyde and application of the method to different biological materials. Chromotographia 52:181–184

    Article  CAS  Google Scholar 

  18. Paglia DE, Valentine WN (1967) Studies on quantitative and qualitive characterization of erythrocyte glutathine peroxidase. J Lab Clin Med 70:158–169

    CAS  PubMed  Google Scholar 

  19. Corretti MC, Anderson TJ, Benjamin EJ et al (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 39(2):257–265

    Article  PubMed  Google Scholar 

  20. Celermajer DS, Sorensen KE, Gooch VM et al (1992) Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 340(8828):1111–1115

    Article  CAS  PubMed  Google Scholar 

  21. Kocak H, Gumuslu S, Sahin E et al (2009) Advanced oxidative protein products are independently associated with endothelial function in peritoneal dialysis patients. Nephrology (Carlton) 14(3):273–280

    Article  CAS  Google Scholar 

  22. Lykkesfeldt J (2007) Malondialdehyde as biomarker of oxidative damage to lipids caused by smoking. Clin Chim Acta 380(1–2):50–58

    Article  CAS  PubMed  Google Scholar 

  23. Oberg BP, McMenamin E, Lucas FL et al (2004) Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 65(3):1009–1016

    Article  PubMed  Google Scholar 

  24. Puchades MJ, Saez G, Munos MC et al (2013) Study of oxidative stress in patients with advanced renal disease and undergoing either hemodialysis or peritoneal dialysis. Clin Nephrol 80(3):177–186

    Article  CAS  PubMed  Google Scholar 

  25. Santangelo F, Witko-Sarsat V, Drüeke T, Descamps-Latscha B (2004) Restoring glutathione as a therapeutic strategy in chronic kidney disease. Nephrol Dial Transplant 19(8):1951–1955

    Article  CAS  PubMed  Google Scholar 

  26. Ahmadpoor P, Eftekhar E, Nourooz-Zadeh J et al (2009) Glutathione, glutathione-related enzymes, and total antioxidant capacity in patients on maintenance dialysis. Iran J Kidney Dis 3(1):22–27

    PubMed  Google Scholar 

  27. Stępniewska J, Dołęgowska B, Popińska M et al (2014) Prooxidative-antioxidative balance of cells in different types of renal replacement therapy. Blood Purif 37(1):4–11

    Article  PubMed  Google Scholar 

  28. Dickinson KM, Keogh JB, Clifton PM (2009) Effects of a low-salt diet on flow-mediated dilatation in humans. Am J Clin Nutr 89(2):485–490

    Article  CAS  PubMed  Google Scholar 

  29. Tzemos N, Lim PO, Wong S et al (2008) Adverse cardiovascular effects of acute salt loading in young normotensive individuals. Hypertension 51(6):1525–1530

    Article  CAS  PubMed  Google Scholar 

  30. Fang Y, Mu JJ, He LC et al (2006) Salt loading on plasma asymmetrical dimethylarginine and the protective role of potassium supplement in normotensive salt-sensitive asians. Hypertension 48(4):724–729

    Article  CAS  PubMed  Google Scholar 

  31. Dunlop JL, Vandal AC, de Zoysa JR et al (2013) Rationale and design of the Sodium Lowering In Dialysate (SoLID) trial: a randomised controlled trial of low versus standard dialysate sodium concentration during hemodialysis for regression of left ventricular mass. BMC Nephrol 14:149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sayarlıoglu H, Erkoc R, Tuncer M et al (2007) Effects of low sodium dialysate in chronic hemodialysis patients: an echocardiographic study. Ren Fail 29(2):143–146

    Article  PubMed  Google Scholar 

  33. Kalantar-Zadeh K, Regidor DL, Kovesdy CP et al (2009) Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation 119:671–679

    Article  PubMed  PubMed Central  Google Scholar 

  34. Capusa C, Mircescu G (2010) Oxidative stress, renal anemia, and its therapies: Is there a link? J Ren Nutr 20(5 Suppl):71–76

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Uskudar State Hospital, 34000, Istanbul, Turkey

    Beyza Macunluoglu

  2. Department of Cardiology, Yuzuncu Yil University, 65200, Van, Turkey

    Hasan Ali Gumrukcuoglu, Aytac Akyol & Serkan Akdag

  3. Department of Nephrology, Fatih Sultan Mehmet Training Hospital, 34000, Istanbul, Turkey

    Aydin Atakan

  4. Department of Biochemistry, Yuzuncu Yil University, 65200, Van, Turkey

    Halit Demir & Hamit Hakan Alp

  5. Department of Nephrology, Kartal Training Hospital, 34890, Istanbul, Turkey

    Ahmet Yavuz & Elif Ari

  6. Department of Nephrology, Yeditepe University, 34890, Istanbul, Turkey

    Zehra Eren

  7. Department of Biostatistics, Yuzuncu Yil University, 65000, Van, Turkey

    Sıddık Keskin

Authors
  1. Beyza Macunluoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hasan Ali Gumrukcuoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aydin Atakan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Halit Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hamit Hakan Alp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aytac Akyol
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Serkan Akdag
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ahmet Yavuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zehra Eren
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sıddık Keskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Elif Ari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elif Ari.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Macunluoglu, B., Gumrukcuoglu, H.A., Atakan, A. et al. Lowering dialysate sodium improves systemic oxidative stress in maintenance hemodialysis patients. Int Urol Nephrol 48, 1699–1704 (2016). https://doi.org/10.1007/s11255-016-1367-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-016-1367-z

Keywords

Search

Navigation