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Research Methods in Nursing February 21, 2012

What is the Relationship between Fluid Volume, Sodium Intake and Blood Pressure for End Stage Renal Disease in the Interdialytic Period?

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Hypertension is a frequent symptom not only in the general population but also among hemodialysis patients. Approximately 72 million Americans have been diagnosed with hypertension and almost 10 million are classified with Stage 3 Chronic Kidney Disease. Hypertension (HTN) is a main reason for End Stage Renal Disease (ESRD). It is rated as the second major cause of ESRD (Hopkins, K. and Bakris G.L. 2009). Two thirds of all cases of chronic kidney failure are due to Diabetes and or hypertension (Kubaki, Carter, Herrera, Wang, 2009). Many health care practitioners are aware that the control of blood pressure is necessary in order to prevent cardiovascular diseases.

Because hypertension is not properly controlled, cardiovascular mortality and morbidity are increased in adult and pediatric hemodialysis (HD) patients (Chavers, B.M., et al. 2009). In the first year of treatment (Dialysis), the mortality rate is approximately 20% and after 5 years it is about 70%. The combination of traditional risk factors such as HTN, dyslipidemia and others factors like uremia, inflammatory status, oxidative stress is responsible for 50% of deaths in HD. And only 20% of the patients are under normal values of BP without antihypertensive medications. (Vieira da Silva, G., De Barros, S., Abensur, H., Coelho Ortega, K., Mion Jr., D. 2009)

Frequently, dialysis with ultrafiltration tends to decrease the values of the blood pressure, but in 10-15 % of the patients BP can increase with dialysis. High mortality rates have been demonstrated in this specific type of HTN (Agarwal, R., and Light, R.P. 2010). Thein, Haloob & Marshall, in 2007 showed that the dialysate is another contributor to HTN in dialysis. Systolic and diastolic blood pressure was reduced when the amount of Sodium in the dialysate was decreased. Theory- based research has considered that compliance to dietary recommendations is an important factor to why the patient has depressive and cognitive responses. Nurses have to focus on the creation of interventions that contribute to the achievement of fluid controls.

Managing the fluids has to be effective in the treatment of dialysis patients. Barnett, T., Li Yoong, T., Pinikahana, J., and Si-Yen T. (2008) found that Nephrology nurses play a significant role in providing education and understanding in these patients that fail to comply with their dietary requirements.

Nephrology nurses are in a position of assisting the dialysis patients in the management of this disease. The nurse will be the one who educates the patient about the dialysis process, she will show him how to monitor his blood pressure at home, as well as fluid consumption and sodium intake. This will contribute to a more compliant patient with better outcomes. (Kauric-Klein & Artinian, 2007)

Nurses are key players and essential for a dialysis patient. Setting care objectives, performing the actions recognized, and establishing goals and achieving results as part of the nursing process is a distinctive feature for the positive outcome of the patient. This was proven by the expenditures made during hospitalizations that appeared in the first 90 days after the initiation of dialysis (Dixon et al., 2011).

Purpose of the study

The reason of this study is to assess the relationship between different parameters that are related with hypertension in patients under dialytic therapy.

Research Question

What is the relationship between fluid volume, sodium intake and blood pressure in End Stage Renal Disease (ESRD) in the interdialytic period?


Agarwal, R., and Light, R.P. (2010) Interdialytic Hypertension is a Marker of Volume Excess Nephrology Dial Transplant 25: 3355-3361 doi: 10.1093/ndt/gfq210

Barnett, T., Li Yoong, T., Pinikahana, J., Si-Yen, T. (2008) Fluid Compliance among patients having Haemodialysis: Can an Educational Programme make a difference? Journal of Advanced Nursing 61(3) 300-306 doi: 10.1111/j.1365-2648.2007.04528.x

Chavers, B.M., Solid, C.A., Daniels, F.X., Chen, S., Collins, A.J., Frankenfield, D.L., Herzog, C.A.( 2009) Hypertension in Pediatric Long term Hemodialysis Patients in the United States. Clin J Am Soc Nephrol 4: 1363-1369

Dixon, J., Borden, P., Kaneko, T. M., & Schoolwerth, A. C. (2011). Multidisciplinary CKD Care Enhances Outcomes at Dialysis Initiation. Nephrology Nursing Journal, 38(2), 165-171

Hopkins, K. and Bakris G.L. (2009) Hypertension Goals in Advanced-Stage Kidney Disease Clin J Am Soc Nephrol 4: S92-S94 doi: 10.2215/CJN.04090609

Kauric-Klein, Z., & Artinian, N. (2007) Improving Blood Pressure control in Hypertensive Hemodialisis The CANNT Journal 17 (4), 24-30 Kubacki, M, Carter, C, Herrera, A, Wang, J, (2009).

Health Plan Retention and Pharmacy Costs of Newly Diagnosed Patients with Chronic Kidney Disease in a Managed Care Population. American Health and Drug Benefits, 2 (7) 283-290

Vieira da Silva, G., De Barros, S., Abensur, H., Coelho Ortega, K., Mion Jr., 2009). Home Blood pressure monitoring in Blood Pressure Control among Haemodialysis Patients: an Open Randomized Clinical Trial Nephrol Dial Transplant 24: 3805-3811 doi: 10.1093/ndt/gfp332

Thein, H,. Haloob, I,. Marshall, M. (2007). Associations of a facility level decrease in dialysate Sodium concentration with blood pressure and interdialytic weight gain, Nephrology Dialysis Transplant 22:2630-2639. doi: 10.1093/ndt/gfm220

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