Cargando…
The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload
BACKGROUND: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialys...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
S. Karger AG
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346930/ https://www.ncbi.nlm.nih.gov/pubmed/28413417 http://dx.doi.org/10.1159/000453674 |
_version_ | 1782513977283051520 |
---|---|
author | Trinh, Emilie Weber, Catherine |
author_facet | Trinh, Emilie Weber, Catherine |
author_sort | Trinh, Emilie |
collection | PubMed |
description | BACKGROUND: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate the 6-month risk of hospitalization and mortality in relation to sodium gradient. METHODS: We performed a cross-sectional study of 110 prevalent conventional hemodialysis patients at a single center. The associations of sodium gradient with interdialytic weight gain index (IDWG%), ultrafiltration (UF) rate, and blood pressure (BP) were analyzed. RESULTS: The mean serum sodium gradient was 4.6 ± 3.6 mEq/L. There was a direct correlation between sodium gradient and IDWG% (r = 0.48, p < 0.01) as well as UF rate (r = 0.44, p < 0.01). In a logistic regression model, a 1 mEq/L higher sodium gradient was associated with increased risk of IDWG% >3% (OR 1.33, p < 0.01) and increased risk of UF rate >10 mL/kg/h (OR 1.16, p = 0.03), but there were no associations with intradialytic hypotension, intradialytic hypertension or BP. No significant differences were found with 6-month hospitalization or mortality risk in relation to sodium gradient. CONCLUSION: A higher sodium gradient was associated with significant increases in IDWG and UF rates, known to be associated with poor outcomes, but was not associated with intradialytic hypotension. Individualizing the dialysate sodium prescription to minimize sodium gap may lead to less fluid overload in conventional hemodialysis patients. |
format | Online Article Text |
id | pubmed-5346930 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | S. Karger AG |
record_format | MEDLINE/PubMed |
spelling | pubmed-53469302017-04-14 The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload Trinh, Emilie Weber, Catherine Nephron Extra Original Paper BACKGROUND: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate the 6-month risk of hospitalization and mortality in relation to sodium gradient. METHODS: We performed a cross-sectional study of 110 prevalent conventional hemodialysis patients at a single center. The associations of sodium gradient with interdialytic weight gain index (IDWG%), ultrafiltration (UF) rate, and blood pressure (BP) were analyzed. RESULTS: The mean serum sodium gradient was 4.6 ± 3.6 mEq/L. There was a direct correlation between sodium gradient and IDWG% (r = 0.48, p < 0.01) as well as UF rate (r = 0.44, p < 0.01). In a logistic regression model, a 1 mEq/L higher sodium gradient was associated with increased risk of IDWG% >3% (OR 1.33, p < 0.01) and increased risk of UF rate >10 mL/kg/h (OR 1.16, p = 0.03), but there were no associations with intradialytic hypotension, intradialytic hypertension or BP. No significant differences were found with 6-month hospitalization or mortality risk in relation to sodium gradient. CONCLUSION: A higher sodium gradient was associated with significant increases in IDWG and UF rates, known to be associated with poor outcomes, but was not associated with intradialytic hypotension. Individualizing the dialysate sodium prescription to minimize sodium gap may lead to less fluid overload in conventional hemodialysis patients. S. Karger AG 2017-02-09 /pmc/articles/PMC5346930/ /pubmed/28413417 http://dx.doi.org/10.1159/000453674 Text en Copyright © 2017 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. |
spellingShingle | Original Paper Trinh, Emilie Weber, Catherine The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload |
title | The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload |
title_full | The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload |
title_fullStr | The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload |
title_full_unstemmed | The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload |
title_short | The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload |
title_sort | dialysis sodium gradient: a modifiable risk factor for fluid overload |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346930/ https://www.ncbi.nlm.nih.gov/pubmed/28413417 http://dx.doi.org/10.1159/000453674 |
work_keys_str_mv | AT trinhemilie thedialysissodiumgradientamodifiableriskfactorforfluidoverload AT webercatherine thedialysissodiumgradientamodifiableriskfactorforfluidoverload AT trinhemilie dialysissodiumgradientamodifiableriskfactorforfluidoverload AT webercatherine dialysissodiumgradientamodifiableriskfactorforfluidoverload |