<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0872-0169</journal-id>
<journal-title><![CDATA[Portuguese Journal of Nephrology & Hypertension]]></journal-title>
<abbrev-journal-title><![CDATA[Port J Nephrol Hypert]]></abbrev-journal-title>
<issn>0872-0169</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Nefrologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0872-01692021000400226</article-id>
<article-id pub-id-type="doi">10.32932/pjnh.2021.12.155</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Clinical impact of personalized sodium prescriptions in hemodialysis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Colaço]]></surname>
<given-names><![CDATA[Susana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[José Paulo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Garcia de Orta Nephrology Department ]]></institution>
<addr-line><![CDATA[Almada ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>35</volume>
<numero>4</numero>
<fpage>226</fpage>
<lpage>232</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0872-01692021000400226&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0872-01692021000400226&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0872-01692021000400226&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Dialysate sodium prescription is often standardized. In some patients, this can be hypernatremic compared to serum sodium, causing a positive sodium balance at the end of treatment that will contribute to increased extracellular volume and interdialytic weight gain. A prospective study was carried out to monitor and compare the clinical implications between different prescriptions of sodium dialysate (isonatremic versus hyponatremic hemodialysis). For that purpose, we included hemodialysis patients in treatment for at least 9 months. The individual sodium setpoint was determined through the median of pre-dialysis sodium measurements, carried out for 6 treatments. The prescribed dialysate sodium was equal to the setpoint (isonatremic period) for 4 weeks and then 2 meq/L inferior to the setpoint (hyponatremic period) for another 4 weeks. The main outcome was interdialytic weight gain. Secondary outcomes were ultrafiltration rate, blood pressure at the beginning of treatment, intradialytic complications, and qualitative assessment of symptoms. Twenty patients were included. Pre-dialysis serum sodium assessments in both periods tended to be patient specific with a stable value. The interdialytic weight gain was lower in the hyponatremic period (1.83±0.50 kg versus 2.04±0.58 kg) but without statistical significance (p value=0.387). The same trend was found in mean ultrafiltration and blood pressure. Dialysis complications were low in both periods. The percentage of cramps and hypotension requiring intervention was higher in the hyponatremic period with no statistically significant differences. Concerning thirst, there was a symptomatic improvement with sodium customization. This improvement was even more significant in the hyponatremic period. This study allowed us to reinforce the existence of a &#8220;sodium setpoint&#8221; for each patient and the importance of an individualized dialysis prescription. Our results suggest the safety of using isonatremic hemodialysis with improving patients&#8217; symptoms. Regarding hyponatremic hemodialysis, despite being beneficial, it seemed to be associated with a higher number of complications.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Hypertension]]></kwd>
<kwd lng="en"><![CDATA[Interdialytic Weight]]></kwd>
<kwd lng="en"><![CDATA[Isonatremic Hemodialysis]]></kwd>
<kwd lng="en"><![CDATA[Sodium]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kooman]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Van Der Sande]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Leunissen]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Locatelli]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sodium balance in hemodialysis therapy]]></article-title>
<source><![CDATA[Semin Dial]]></source>
<year>2003</year>
<volume>16</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>351-5</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Canaud]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Kooman]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Selby]]></surname>
<given-names><![CDATA[NM]]></given-names>
</name>
<name>
<surname><![CDATA[Taal]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Francis]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Kopperschmidt]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[odium and water handling during hemodialysis: new pathophysiologic insights and management approaches for improving outcomes in end-stage kidney disease]]></article-title>
<source><![CDATA[Kidney Int. Internet]]></source>
<year>2019</year>
<volume>95</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>296-309</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[SW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sodium balance in maintenance hemodialysis]]></article-title>
<source><![CDATA[Electrolyte Blood Press]]></source>
<year>2012</year>
<volume>10</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-6</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jansen]]></surname>
<given-names><![CDATA[MAM]]></given-names>
</name>
<name>
<surname><![CDATA[Hart]]></surname>
<given-names><![CDATA[AAM]]></given-names>
</name>
<name>
<surname><![CDATA[Korevaar]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Dekker]]></surname>
<given-names><![CDATA[FW]]></given-names>
</name>
<name>
<surname><![CDATA[Boeschoten]]></surname>
<given-names><![CDATA[EW]]></given-names>
</name>
<name>
<surname><![CDATA[Krediet]]></surname>
<given-names><![CDATA[RT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predictors of the rate of decline of residual renal function in incident dialysis patients]]></article-title>
<source><![CDATA[Kidney Int]]></source>
<year>2002</year>
<volume>62</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1046-53</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Flanigan]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[How should dialysis fluid be individualized for the chronic hemodialysis patient?]]></article-title>
<source><![CDATA[Sodium Semin Dial]]></source>
<year>2008</year>
<volume>21</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>226-9</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Donati]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Ursino]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Spazzoli]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Natali]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Schillaci]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Conte]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sodium prescription in the prevention of intradialytic hypotension: new insights into an old concept]]></article-title>
<source><![CDATA[Blood Purif]]></source>
<year>2018</year>
<volume>45</volume>
<numero>1-3</numero>
<issue>1-3</issue>
<page-range>61-70</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Basile]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Libutti]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Lisi]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Vernaglione]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Casucci]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Losurdo]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sodium setpoint and gradient in bicarbonate hemodialysis]]></article-title>
<source><![CDATA[J Nephrol]]></source>
<year>2013</year>
<volume>26</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1136-42</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peixoto]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Gowda]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Parikh]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[SFF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long-term stability of serum sodium in hemodialysis patients]]></article-title>
<source><![CDATA[Blood Purif]]></source>
<year>2010</year>
<volume>29</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>264-7</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Qirjazi]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Salerno]]></surname>
<given-names><![CDATA[FR]]></given-names>
</name>
<name>
<surname><![CDATA[Akbari]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hur]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Penny]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Scholl]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tissue sodium concentrations in chronic kidney disease and dialysis patients by lower leg sodium-23 magnetic resonance imaging]]></article-title>
<source><![CDATA[Nephrol Dial Transplant]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Munoz Mendoza]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Arramreddy]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Schiller]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dialysate sodium: choosing the optimal hemodialysis bath]]></article-title>
<source><![CDATA[Am J Kidney Dis]]></source>
<year>2015</year>
<volume>66</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>710-20</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Weisbord]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
<name>
<surname><![CDATA[Fried]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Arnold]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
<name>
<surname><![CDATA[Rotondi]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Fine]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Levenson]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Development of a symptom assessment instrument for chronic hemodialysis patients: The dialysis symptom index]]></article-title>
<source><![CDATA[J Pain Symptom Manage]]></source>
<year>2004</year>
<volume>27</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>22-2240</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Paula]]></surname>
<given-names><![CDATA[FM]]></given-names>
</name>
<name>
<surname><![CDATA[Peixoto]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Pinto L]]></surname>
<given-names><![CDATA[V.]]></given-names>
</name>
<name>
<surname><![CDATA[Dorigo]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Patricio]]></surname>
<given-names><![CDATA[PJM]]></given-names>
</name>
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[SFF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients]]></article-title>
<source><![CDATA[Kidney Int]]></source>
<year>2004</year>
<volume>66</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1232-8</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Thomson]]></surname>
<given-names><![CDATA[BK]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Lindsay]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical effects of personalized dialysate sodium in conventional, quotidian, and nocturnal home hemodialysis patients: a randomized crossover trial]]></article-title>
<source><![CDATA[J Clin Exp Nephrol]]></source>
<year>2017</year>
<volume>2</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1-8</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Thein]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Haloob]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Marshall]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Associations of a facility level decrease in dialysate sodium concentration with blood pressure and interdialytic weight gain]]></article-title>
<source><![CDATA[Nephrol Dial Transplant]]></source>
<year>2007</year>
<volume>22</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>2630-9</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dunlop]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Vandal]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Marshall]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Low dialysate sodium levels for chronic haemodialysis]]></article-title>
<source><![CDATA[Cochrane Database Syst Rev]]></source>
<year>2019</year>
<volume>1</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>CD011204</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mistry]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dialysis disequilibrium syndrome prevention and management]]></article-title>
<source><![CDATA[Int J Nephrol Renovasc Dis]]></source>
<year>2019</year>
<volume>12</volume>
<page-range>69-77</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gaillard]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Laplanche]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Petitclerc]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Natremia, tonicity, and conductivity measurements in hemodialyzed patients]]></article-title>
<source><![CDATA[Int J Artif Organs]]></source>
<year>2015</year>
<volume>38</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>288-90</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
