Beyond Sodium: Inflammation as the Strongest Predictor of Mortality Among Non-Diabetic Hemodialysis Patients
Journal
Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki)
ISSN
1857-8985
Date Issued
2026-06-01
Author(s)
Eftimovska-otovikj Natasha
Poposka, Elizabeta
Popovska, Bojana
DOI
10.2478/prilozi-2026-0026
Abstract
: Standard dialysate sodium concentration (sDNa) may not adequately reflect individual sodium requirements in each hemodialysis patient, potentially contributing to interdialytic weight gain (IDWG), hypertension and inflammation. The aim of this study was to compare clinical and biochemical outcomes between individualized and standard dialysate sodium prescriptions and to assess factors associated with mortality. : This was a prospective interventional study conducted in two phases. In the first phase, patients were treated with standard hemodialysis (HD) using a fixed dialysate sodium concentration of 138 mmol/L. In the second phase, dialysate sodium was individualized based on each patient's pre-dialysis serum sodium concentration. Each patient served as their own control. Outcomes included IDWG, blood pressure, thirst score, dialysis adequacy (Kt/V, URR), nutritional markers, C-reactive protein (CRP), electrolytes, and mortality. : Individualized dialysate sodium prescription was associated with a significant reduction in IDWG (1.93 ± 0.64 vs 2.17 ± 0.79 kg; p = 0.001) and improved dialysis adequacy (Kt/V: 1.50 ± 0.24 vs 1.36 ± 0.22; p < 0.001). Survivors had higher serum albumin levels and lower CRP values compared to non-survivors. Serum and dialysate sodium concentrations were not independently associated with mortality. In logistic regression analysis, CRP >10 mg/L showed the strongest observed association with mortality (OR 10.278; 95% CI 1.709-61.826; p = 0.011). : Individualized dialysate sodium prescription may improve fluid control and dialysis adequacy in selected patients. Inflammation was significantly associated with mortality in this cohort; however, results should be interpreted with caution due to the limited number of events.