University College London

ILD118

There are approximately 24,000 people receiving dialysis in the UK with around 7000 new patients starting each year. Unfortunately, survival on dialysis is worse than for most cancers, and more than half of the deaths among people on dialysis are due to cardiovascular (heart) disease. Dialysate sodium concentrations (the amount of salt in the fluid that washes the blood) have drawn recent attention due to the theory that lower concentrations will enhance sodium removal, minimise fluid overload and hypertension, and so reduce the high rates of cardiovascular disease that afflict those receiving dialysis. In setting up a dialysis machine for each dialysis session, there are many variables that need to be programmed including the concentrations of sodium and calcium in the dialysate fluid, the temperature of the dialysate and the length of the dialysis session. There are no universally accepted standards for these settings and most dialysis centres simply apply “default” values. The lack of standardisation in the UK is reflected in a recent survey in which dialysis centres reported default dialysis sodium concentrations ranging from 135 to 140 mmol/l. Small studies suggest that sodium levels closer to 135mmol/l may increase the removal of excess salt from the body and reduce fluid build-up, which reduces the risks of heart disease and strokes. The same studies also suggest that levels closer to 140mmol/l may make the dialysis procedure more stable by lowering the chance of blood pressure dropping during the dialysis session. So, what is the right level of dialysate sodium? Both higher and lower may be beneficial what level should a dialysis centre choose? The RESOLVE study will determine if a lower or higher dialysate sodium setting is preferable. The results of the RESOLVE study will be used in the future as practice guidelines.