关键词: 高血压, 血液透析, 血液透析液, 钠, 血压, 多中心研究

Abstract: Background　Hypertension is one of the common complications in end-stage renal disease patients undergoing maintenance hemodialysis.Previous studies have shown that lowering dialysate sodium concentration could adjust the water and sodium retention and thus reduce the blood pressure in end-stage renal disease patients with hypertension and maintenance hemodialysis，however，most of these studies have a small sample size，and the clinical significance of lowering dialysate sodium concentration is still controversial.Objective　 To verify the effect and safety of lowering dialysate sodium concentration for controlling blood pressure and plasma sodium in a large sample of end-stage renal disease patients with hypertension，dry weight and maintenance hemodialysis.Methods　In this multicenter，self-controlled study，154 end-stage renal disease patients with hypertension and maintenance hemodialysis from seven blood purifying centers in Beijing were enrolled between September and November 2018.The dialysate sodium concentration of them was adjusted to 138 mmol/L on December 1，2018 and maintained to December 31，2018（defined as pre-intervention），then adjusted to 136 mmol/L on January 1，2019 and maintained to April 30， 2019（defined as post-intervention）.Pre-hemodialysis plasma hemoglobin，albumin，calcium，phosphorus，parathormone，systolic and diastolic blood pressure，pre- and post-hemodialysis plasma sodium measured in the last week of December 2018 and the first week of May 2019 were compared.Interdialytic dry weight gain，kinds of antihypertensive drugs being used and incidence of adverse events during hemodialysis were recorded.Results　The average pre- and post-intervention pre-hemodialysis plasma hemoglobin，albumin，calcium，phosphorus and parathormone in all cases were not significantly different（P>0.05），but the average pre- and post-hemodialysis plasma sodium，pre-hemodialysis systolic and diastolic blood pressure，and interdialytic dry weight gain as well as the kinds of antihypertensive drugs being used showed significant reduction after intervention（P<0.05）.There was no significant difference in incidence of hypotension or muscle spasm during hemodialysis before and after intervention（P>0.05）.Conclusion　Mildly lowering dialysate sodium concentration may effectively reduce the blood pressure and plasma sodium in end-stage renal disease patients with hypertension，dry weight，and maintenance hemodialysis，with relatively high safety，which is worthy of appropriate promotion in primary hemodialysis institutions.

Key words: Hypertension, Hemodialysis, Hemodialysis solutions, Sodium, Blood pressure, Multicenter study