Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study.

Autor: Paglialonga F; Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabio.paglialonga@policlinico.mi.it., Shroff R; University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK., Zagozdzon I; Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland., Bakkaloglu SA; Department of Pediatric Nephrology, Gazi University, Ankara, Turkey., Zaloszyc A; Department of Pediatric Nephrology, Hopital de Hautepierre, Strasbourg, France., Jankauskiene A; Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania., Gual AC; Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain., Consolo S; Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy., Grassi MR; Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy., McAlister L; University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK., Skibiak A; Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland., Yazicioglu B; Department of Pediatric Nephrology, Gazi University, Ankara, Turkey., Puccio G; Department of Sciences for Health Promotion, University of Palermo, Palermo, Italy., Edefonti A; Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy., Ariceta G, Aufricht C, Holtta T, Klaus G, Ranchin B, Schmitt CP, Snauwaert E, Stefanidis C, Walle JV, Stabouli S, Verrina E, Vidal E, Vondrak K, Zurowska A
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2023 Oct; Vol. 38 (10), pp. 3389-3399. Date of Electronic Publication: 2023 Mar 29.
DOI: 10.1007/s00467-023-05932-y
Abstrakt: Background: Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis.
Methods: Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa). Primary outcomes were systolic blood pressure and diastolic blood pressure standard deviation scores (SBP and DBP SDS), obtained by 24-h ambulatory blood pressure monitoring or office BP according to age, and interdialytic weight gain (IDWG).
Results: Forty-one patients (31 HD), with a median age of 13.3 (IQR 5.2) years, were enrolled. Twelve patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.7) mEq/kg/day. Median total Na intake was 1.5 (1.1) mEq/kg/day, corresponding to 60.6% of the maximum recommended daily intake for healthy children. Median uNa and sNaB were 0.6 (1.8) mEq/kg/day and 0.9 (1.7) mEq/kg/day, respectively. The strongest independent predictor of sNaB in the cohort was urine output. In patients receiving HD, sNaB correlated with IDWG, pre-HD DBP, and first-hour refill index, a volume index based on blood volume monitoring. sNaB was the strongest predictor of IDWG in multiple regression analysis (β = 0.63; p = 0.005). Neither SBP SDS nor DBP SDS correlated with sNaB.
Conclusions: Na intake is higher than uNa in children on dialysis, and medications may be an important source of Na. sNaB is best predicted by urine output in the population, and it is a significant independent predictor of IDWG in children on HD. A higher resolution version of the Graphical abstract is available as Supplementary information.
(© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)
Databáze: MEDLINE
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