Dextrose solution for priming and rinsing the extracorporeal circuit in hemodialysis patients: A prospective pilot study

Abstract

Introduction: Excess sodium intake and consequent volume overload are major clinical problems in hemodialysis (HD) contributing to adverse outcomes. Saline used for priming and rinsing of the extracorporeal circuit is a potentially underappreciated source of intradialytic sodium gain. We aimed to examine the feasibility and clinical effects of replacing saline as the priming and rinsing fluid by a 5% dextrose solution.

Materials and methods: We enrolled non-diabetic and anuric stable HD patients. First, the extracorporeal circuit was primed and rinsed with approximately 200-250 mL of isotonic saline during 4 weeks (Phase 1), subsequently a similar volume of a 5% dextrose solution replaced the saline for another 4 weeks (Phase 2), followed by another 4 weeks of saline (Phase 3). We collected data on interdialytic weight gain (IDWG), pre- and post-dialysis blood pressure, intradialytic symptoms, and thirst.

Results: Seventeen chronic HD patients (11 males, age 54.1 ± 18.7 years) completed the study. The average priming and rinsing volumes were 236.7 ± 77.5 and 245.0 ± 91.8 mL respectively. The mean IDWG did not significantly change (2.52 ± 0.88 kg in Phase 1; 2.28 ± 0.70 kg in Phase 2; and 2.51 ± 1.2 kg in Phase 3). No differences in blood pressures, intradialytic symptoms or thirst were observed.

Conclusions: Replacing saline by 5% dextrose for priming and rinsing is feasible in stable HD patients and may reduce intradialytic sodium loading. A non-significant trend toward a lower IDWG was observed when 5% dextrose was used. Prospective studies with a larger sample size and longer follow-up are needed to gain further insight into the possible effects of using alternate priming and rinsing solutions lowering intradialytic sodium loading.

Trial registration: Identifier NCT01168947 (ClinicalTrials.gov).

Keywords: Hemodialysis; apheresis and detoxification techniques; artificial kidney; dextrose 5%; dialysis fluids; extracorporeal circuit; interdialytic weight gain; isotonic saline; priming and rinsing; sodium loading; thirst.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: PK, ST, and JGR are employed by the Renal Research Institute (affiliated with Fresenius Medical Care North America). PK holds stock in Fresenius Medical Care. ST holds performance shares in Fresenius Medical Care. All the other authors declare that they have no conflict of interest.

Figures

Figure 1.

Study flowchart. The solution for priming and rinsing was changed during the study. In weeks 1–4 (Phase 1) saline 0.9% was used; in weeks 5–8 (Phase 2) a dextrose 5% solution; and in weeks 9–12 (Phase 3) the priming and rinsing solution was switched back to saline 0.9%. At the time points blood pressure was measured under controlled conditions and thirst questionnaires were completed. wks: weeks; NaCl 0.9%: sodium chloride 0.9%.

Figure 2.

Absolute and relative IDWG in the three Phases. The mean absolute interdialytic weight gain (IDWG) in kilograms and the relative IDWG change as percentage (%) of body weight (IDWG/post-dialysis weight) among the 3 study phases are expressed with standard deviation (SD). Phase 1: NaCl 0.9%; Phase 2: Dextrose 5%; Phase 3: NaCl 0.9%.