Are Observational Reports on the Association of Dialysate Sodium with Mortality Enough to Change Practice? Perspective from the RESOLVE Study Team

Smyth, Brendan; Krishnasamy, Rathika; Jardine, Meg; ,

doi:10.1681/asn.0000000000000289

JASN

2023

DOI: 10.1681/asn.0000000000000289

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Are Observational Reports on the Association of Dialysate Sodium with Mortality Enough to Change Practice? Perspective from the RESOLVE Study Team

Brendan Smyth,

Rathika Krishnasamy,

Meg Jardine

Abstract: See related article, "Effect of Dialysate and Plasma Sodium on Mortality in a Global Historical Hemodialysis Cohort," on pages 167-176.

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2024

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Does using a higher dialysate sodium concentration result in lower sodium losses with dialysis treatments?

Chhabra,

Davenport

2024

Ren Replace Ther

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Introduction Many dialysis centres prescribe a uniform dialysate sodium (DialNa) concentration, but as there is no consensus on the choice of a universal DialNa, we wished to determine dialysate sodium balance comparing DialNa of 140 and < 140 mEq/L. Methods Waste dialysate was continuously collected during sessions and thoroughly mixed, and sodium was measured in both the waste and fresh dialysate. Sodium removal was calculated as the difference in concentrations, dialysate flow rate, session time and ultrafiltration. Results Dialysate sodium balance was measured during 139 dialysis treatments (34 DialNa 140 versus 105 DialNa < 140, median 136 mEq/L), in 111 patients, 63% male, mean age 64.0 ± 16.2 years and 33.3% diabetic. There was no difference using the higher DialNa [net loss median 482 (238–573) versus 312 (124–599) mEq], ultrafiltration losses [226 (131–280) versus 204 (125–290)mEq] and non-ultrafiltration losses [217 (0–384) versus 173 (−90 to 350)mEq]. We also compared haemodiafiltration and haemodialysis (118 versus 23 sessions), and there were no differences in net loss [311 (91–608) versus 381 (167–597)], ultrafiltration [212 (127–290) versus 169 (110–258)mEq] and non-ultrafiltration losses [180 (−51 to 386) versus 192 (−74 to 387)mEq]. Conclusions Although most dialysis centres prescribe a universal dialysate sodium concentration, there is no consensus on the optimum universal concentration. We found no difference in net dialysate sodium balance when comparing patients dialysing with a dialysate sodium concentration of 140 or < 140 mEq/L. Similarly, we found no differences in dialysate sodium balance between haemodiafiltration and haemodialysis sessions.

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Does using a higher dialysate sodium concentration result in lower sodium losses with dialysis treatments?

Chhabra,

Davenport

2024

Ren Replace Ther

View full text Add to dashboard Cite

show abstract

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Are Observational Reports on the Association of Dialysate Sodium with Mortality Enough to Change Practice? Perspective from the RESOLVE Study Team

Abstract: See related article, "Effect of Dialysate and Plasma Sodium on Mortality in a Global Historical Hemodialysis Cohort," on pages 167-176.

Cited by 1 publication

References 13 publications

Does using a higher dialysate sodium concentration result in lower sodium losses with dialysis treatments?

Does using a higher dialysate sodium concentration result in lower sodium losses with dialysis treatments?

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