The effect of sodium and ultrafiltration profiles on preventing from the complications made during hemodialysis

INTERVENTION: For each group in this research, four different hemodialysis protocols are implemented. These protocols are as follows: Protocol 1: Linear Sodium Dialysate (150 ‐ 138mEq/L) and constant Ultra?ltration. Protocol 2: Constant Sodium Dialysate (140 mEq/L) and gradient ultra?ltration. Protocol 3: Linear Sodium Dialysate (150 ‐ 138 mEq/L) and gradient ultra?ltration. Protocol 4: (standard hemodialysis) = Constant Sodium Dialysate (140 mEq/L) and constant Ultra?ltration. Linear Sodium Dialysate: In the first hour of the dialysis the amount of Sodium dialysate is 150mEq/L, then is gradually decreasing by 4mEq/L per hour. In the last hour of the dialysis, it reaches 138mEq/L. Gradient Ultra?ltration: Two‐thirds of the fluid acquired between 2 dialysis sessions is removed during the first two hours of the dialysis and the reset in the last two hours. This protocol can be programmed on Gambro AK96 dialysis machine. Constant Ultra?ltration: The excessive fluid acquired between hemodialysis is dete For Group B, protocols, 2‐3‐4 and 1 run respectively. For Group C, protocols, 3‐4‐1 and 2 run respectively. For Group D, protocols, 4‐1‐2 and 3 run respectively. Intervention 1: For each group in this research, four different hemodialysis protocols are implemented. These protocols are as follows: Protocol 1: Linear Sodium Dialysate (150 ‐ 138mEq/L) and constant Ultra?ltration. Protocol 2: Constant Sodium Dialysate (140 mEq/L) and gradient ultra?ltration. Protocol 3: Linear Sodium Dialysate (150 ‐ 138 mEq/L) and gradient ultra?ltration. Protocol 4: (standard hemodialysis) = Constant Sodium Dialysate (140 mEq/L) and constant Ultra?ltration. Linear Sodium Dialysate: In the first hour of the dialysis the amount of Sodium dialysate is 150mEq/L, then is gradually decreasing by 4mEq/L per hour. In the last hour of the dialysis, it reaches 138mEq/L. Gradient Ultra?ltration: Two‐thirds of the fluid acquired between 2 dialysis sessions is removed during the first two hours of the dialysis and the reset in the last two hours. This protocol can be programmed on Gambro AK96 dialysis machine. Constant Ultra?ltration: The excessive fluid acquired between hemodialysis is determined. This fluid is taken back in equal volumes in each hour of a four ‐hour dialysis session. Constant Sodium Dialysate: During a four ‐hour ‐dialysis session, sodium dialysate is kept in140 mEq/L. For any patients, six hemodialysis sessions are considered for each of the protocols. For group A, protocols, 1‐2‐3 and 4 run respectively. Intervention 2: For Group B, protocols, 2‐3‐4 and 1 run respectively. Intervention 3: For Group C, protocols, 3‐4‐1 and 2 run respectively. Intervention 4: For Group D, protocols, 4‐1‐2 and 3 run respectively. Prevention CONDITION: End stage kidney disease End stage kidney disease. ; End stage kidney disease PRIMARY OUTCOME: Blood pressure. Timepoint: pre, intra & post dialysis. Method of measurement: Blood pressure based on mm Hg, monitoring by Gambro AK96 dialysis machine. Headache. Timepoint: pre, intra & post dialysis. Method of measurement: with checklist. Muscle cramps. Timepoint: pre, intra & post dialysis. Method of measurement: checklist. Nausea & vomiting. Timepoint: pre, intra & post dialysis. Method of measurement: with checklist. SECONDARY OUTCOME: Plasma osmolality. Timepoint: pre & post dialysis. Method of measurement: Laboratory method. Sodium plasma. Timepoint: pre & post dialysis. Method of measurement: Laboratory method. Urea. Timepoint: pre & post dialysis. Method of measurement: Laboratory method. INCLUSION CRITERIA: INCLUSION CRITERIA: hemodialysis patients in Panje Azar Hospital of Gorgan, who have: 1‐ hypotension for more than three sessions during last month (20 percent of the sessions). 2‐ Age of 18‐75 years. 3‐ hemodialysis for more than three months. 4‐ Dialysis for three times a week with a solution of sodium bicarbonate. 5‐ End‐stage renal diseases. Exclusion criteria: The patients, 1‐ Before starting dialysis, having systolic blood pressure of below 100 mm Hg. 2‐ Patients with complications studied in this project (cramps, nausea, vomiting and headache). 3‐ Administered analgesic, anti‐hypertensive and anti‐spasmodic, four hours before of dialysis.