Severe Hyponatremia and Continuous Renal Replacement Therapy: Safety and Effectiveness of Low-Sodium Dialysate
| Autor: | Chethan Puttarajappa, Paul M. Palevsky, Siddharth Verma, Srijan Tandukar, Catherine Kim, Kartik Kalra |
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| Rok vydání: | 2020 |
| Předmět: |
low sodium dialysate
business.industry Sodium medicine.medical_treatment continuous renal replacement therapy Acute kidney injury chemistry.chemical_element low sodium CRRT medicine.disease End stage renal disease Discontinuation acute kidney injury chemistry Nephrology Anesthesia Internal Medicine medicine Renal replacement therapy Hyponatremia business end stage renal disease Original Research Low sodium Kidney disease |
| Zdroj: | Kidney Medicine |
| ISSN: | 2590-0595 |
| DOI: | 10.1016/j.xkme.2020.05.007 |
| Popis: | Rationale & Objective In patients with severe hyponatremia in the setting of acute kidney injury or end-stage kidney disease, continuous renal replacement therapy (CRRT) using standard-sodium (140 mEq/L) fluids may lead to excessively rapid correction of plasma sodium concentration. Use of dialysate and replacement fluids with reduced sodium concentrations can provide a controlled rate of correction of plasma sodium concentration. Study Design We performed a single-center retrospective analysis of the safety and effectiveness of this approach in patients with plasma sodium concentrations ≤ 126 mEq/L who underwent CRRT for 24 or more hours using low-sodium (119 or 126 mEq/L) dialysate and replacement fluids. Change in plasma sodium level was assessed at 24 and 48 hours after initiation of low-sodium CRRT and at the end of treatment. Setting & Participants Between January 2016 and June 2018, a total of 23 hyponatremic patients underwent continuous venovenous hemodiafiltration using low-sodium dialysate and replacement fluids; 4 patients were excluded from analysis because of CRRT duration less than 6 mEq/L at 24 hours. Mean changes in plasma sodium levels at 24 and 48 hours and at the time of CRRT discontinuation were 3, 3, and 6 mEq/L, respectively. None of the patients developed osmotic demyelination syndrome. Limitations Key limitations were small sample size and lack of a control group. Conclusions Use of low-sodium dialysate and replacement fluids is a safe strategy for the prevention of overly rapid correction of plasma sodium levels in hyponatremic patients undergoing CRRT. Graphical abstract |
| Databáze: | OpenAIRE |
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