Effect of conductance and sodium balance on inter/intra-dialytic symptoms

Objective: To evaluate Patient Reported Outcomes of intra/interdialytic symptoms and to optimize the ideal conductivity settings maintained for minimal symptom expressions. Materials and Methods: A prospective observational study, carried out in a south Indian tertiary care teaching hospital. Patient Reported Outcomes Kidney Disease Quality of Life (KDQOLTM) 35 Symptom List Questionnaire was administered to each patient to determine inter/intradialytic symptoms coupled with sodium conductivity measurement during hemodialysis. Results: Of the 126 study populations, 97 consented were involved, the mean age was 50±11 years, with male predominance of 79%. Of the 31 parameters studied, 9 correlated significantly to conductivity showing some relationship (p<0.05). Muscle cramps, muscle soreness, fatigue, trouble sleeping and nausea were least at population conductivity mean of 14.4 mS/m and peaked at the extremes of mean conductivity range of 13.2 and 15.1 mS/m. Whereas hypotensive symptoms and hot & cold spells were lowest at higher extreme of mean conductivity and peaks at lower end due to sodium removal & hyponatremia. Conclusion: The change in sodium conductivity with response to sodium gradient was associated with significant increases in inter/intra-dialytic symptom rates associated with symptoms like cramps, soreness, fatigue, nausea and trouble sleeping are least severe around a conductivity of 14.5 mS/m.