Abstract
To study the relationship between pre-dialysis plasma sodium and blood pressure (BP), we performed an audit of patients who were on stable haemodialysis at St Bartholomew's and The Royal London Hospital from 1 June 2009 to 15 June 2010. There were 651 patients with 7445 dialysis sessions where both plasma biochemistry and BP were measured before haemodialysis. We found a significant association between plasma sodium and both systolic and diastolic BP. A 1 mmol l−1 increase in plasma sodium was related to 0.65/0.36 mm Hg increase in BP (P<0.001 for both systolic and diastolic BP) after adjusting for potential confounding factors, including weight gain between dialyses and plasma albumin, both of which are crude indices of extracellular fluid volume. A separate analysis excluding individuals who were on BP treatment showed a similar relationship, with a 1-mmol l−1 increase in plasma sodium associated with 0.82/0.56 mm Hg increase in BP (P<0.001 for both, N=177). These results provide further support for the accumulating evidence that plasma sodium has an important role in regulating BP, which may be independent of extracellular volume. Our findings in conjunction with other evidence suggest that small changes in plasma sodium could be an important mechanism for the beneficial effects of lower dialysate sodium and lower salt intake on BP in haemodialysis patients.
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References
He FJ, MacGregor GA . Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis 2010; 52: 363–382.
de Wardener HE, He FJ, MacGregor GA . Plasma sodium and hypertension. Kidney Int 2004; 66: 2454–2466.
Friedman SM . The relation of cell volume, cell sodium and the transmembrane sodium gradient to blood pressure. J Hypertens 1990; 8: 67–73.
Friedman SM, McIndoe RA, Tanaka M . The relation of blood sodium concentration to blood pressure in the rat. J Hypertens 1990; 8: 61–66.
He FJ, Markandu ND, Sagnella GA, de Wardener HE, MacGregor GA . Plasma sodium: ignored and underestimated. Hypertension 2005; 45: 98–102.
Bulpitt CJ, Shipley MJ, Semmence A . Blood pressure and plasma sodium and potassium. Clin Sci 1981; 61 (Suppl 7): 85s–87s.
Komiya I, Yamada T, Takasu N, Asawa T, Akamine H, Yagi N et al. An abnormal sodium metabolism in Japanese patients with essential hypertension, judged by serum sodium distribution, renal function and the renin-aldosterone system. J Hypertens 1997; 15: 65–72.
Rupp JW, Stone RA, Gunning BE . Sodium versus sodium-fluid restriction in hemodialysis: control of weight gains and blood pressures. Am J Clin Nutr 1978; 31: 1952–1955.
Suckling RJ, He FJ, Markandu ND, MacGregor GA . Dietary salt influences postprandial plasma sodium concentration and systolic blood pressure. Kidney Int 2012; 81 (4): 407–411.
Lago RM, Pencina MJ, Wang TJ, Lanier KJ, D’Agostino RB, Kannel WB et al. Interindividual variation in serum sodium and longitudinal blood pressure tracking in the Framingham Heart Study. J Hypertens 2008; 26: 2121–2125.
Suckling RJ, Swift P, Markandu N, He F, MacGregor GA . Altering plasma sodium concentration rapidly changes blood pressure during haemodialysis. J Human Hypertens 2010; 24: S10.
Locatelli F, Covic A, Chazot C, Leunissen K, Luno J, Yaqoob M . Optimal composition of the dialysate, with emphasis on its influence on blood pressure. Nephrol Dial Transplant 2004; 19: 785–796.
Farmer CKT, Donohoe P, Dallyn P, Cox J, Kingswood JC, Goldsmith DJA . Low-sodium haemodialysis without fluid removal improves blood pressure control in chronic haemodialysis patients. Nephrology 2000; 5: 237–241.
Davenport A, Cox C, Thuraisingham R . The importance of dialysate sodium concentration in determining interdialytic weight gains in chronic hemodialysis patients: the PanThames Renal Audit. Int J Artif Organs 2008; 31: 411–417.
Krautzig S, Janssen U, Koch KM, Granolleras C, Shaldon S . Dietary salt restriction and reduction of dialysate sodium to control hypertension in maintenance haemodialysis patients. Nephrol Dial Transplant 1998; 13: 552–553.
Davenport A . Audit of the effect of dialysate sodium concentration on inter-dialytic weight gains and blood pressure control in chronic haemodialysis patients. Nephron Clin Pract 2006; 104: c120–c125.
Flanigan MJ . How should dialysis fluid be individualized for the chronic hemodialysis patient? Sodium. Semin Dial 2008; 21: 226–229.
Gu J, Anand V, Shek E, Moore M, Brady A, Kelly W et al. Sodium induces hypertrophy of cultured myocardial myoblasts and vascular smooth muscle cells. Hypertension 1998; 31: 1083–1087.
Li J, White J, Guo L, Zhao X, Wang J, Smart EJ et al. Salt inactivates endothelial nitric oxide synthase in endothelial cells. J Nutr 2009; 139: 447–451.
Oberleithner H, Riethmuller C, Schillers H, MacGregor GA, de Wardener HE, Hausberg M . Plasma sodium stiffens vascular endothelium and reduces nitric oxide release. PNAS 2007; 104: 16281–16286.
Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995; 25: 305–313.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.
Franklin SS . Pulse pressure as a risk factor. Clin Exp Hypertens 2004; 26: 645–652.
Gasowski J, Fagard RH, Staessen JA, Grodzicki T, Pocock S, Boutitie F et al. Pulsatile blood pressure component as predictor of mortality in hypertension: a meta-analysis of clinical trial control groups. J Hypertens 2002; 20: 145–151.
Dolson GM, Ellis KJ, Bernardo MV, Prakash R, Adrogue HJ . Acute decreases in serum potassium augment blood pressure. Am J Kidney Dis 1995; 26: 321–326.
Fogh-Andersen N, Hedegaard L, Thode J, Siggaard-Andersen O . Sex-dependent relation between ionized calcium in serum and blood pressure. Clin Chem 1984; 30: 116–118.
Sangal AK, Beevers DG . Serum calcium and blood pressure. Lancet 1982; 2: 493.
Hostmark AT, Tomten SE, Berg JE . Serum albumin and blood pressure: a population-based, cross-sectional study. J Hypertens 2005; 23: 725–730.
Mehrotra R, Duong U, Jiwakanon S, Kovesdy CP, Moran J, Kopple JD et al. Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis. Am J Kidney Dis 2011; 58: 418–428.
Acknowledgements
We thank Ms Mira Varagunam for her help with the preliminary data analysis. We are grateful to Professor Hugh E de Wardener for his helpful comments on the manuscript.
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He, F., Fan, S., MacGregor, G. et al. Plasma sodium and blood pressure in individuals on haemodialysis. J Hum Hypertens 27, 85–89 (2013). https://doi.org/10.1038/jhh.2012.9
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DOI: https://doi.org/10.1038/jhh.2012.9
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