What's in the Poster

Row 1 — Background & Science

• Definition: SBP drop ≥ 20 mmHg or MAP drop ≥ 10 mmHg during HD
• Incidence: 20–30% of sessions
• Pathophysiology flow: Ultrafiltration → ↓ Intravascular Volume → Slow Plasma Refilling → ↓ Preload → IDH
• Risk factors listed (high UF rate, low albumin, cardiac dysfunction, autonomic neuropathy, etc.)

• Dynamic variation of dialysate Na⁺ during a session (not a fixed constant)
• Standard: starts 145–155 mmol/L → tapers to 135–138 mmol/L
• Three pattern types: Linear Decline, Stepwise Decline, Sine/Cyclic wave

1. High early dialysate Na⁺ creates an osmotic gradient between blood and dialysate
2. ↑ Serum osmolality draws fluid from interstitial and intracellular space into the intravascular compartment
3. Plasma refilling rate accelerates — maintaining intravascular volume during active UF
4. Adequate cardiac preload preserved → BP stabilises → IDH prevented
5. As Na⁺ tapers later in session, osmotic load reduces — limiting net positive Na⁺ balance

Row 2 — Clinical Application

• Reduces symptomatic IDH episodes
• Stabilises relative blood volume (RBV) during UF
• Increases absolute plasma refill rate vs. fixed-Na⁺ dialysate
• Stepwise profiling validated in meta-analysis (Dunne, Hemodial Int 2017)

• Sodium loading → ↑ thirst → ↑ IDWG → ↑ next-session UF → vicious cycle
• May aggravate hypertension in volume-overloaded patients
• Must re-evaluate monthly for signs of Na⁺ overload
• Target dialytic Na⁺ balance with conductivity monitoring

⚠ Avoid sodium profiling as a routine fix for IDWG — treat volume overload first.