The Importance of Dialysate Sodium Concentration in Determining Interdialytic Weight Gains in Chronic Hemodialysis Patients: The PanThames Renal Audit

Davenport, Andrew; Cox, Claire; Thuraisingham, Raj

doi:10.1177/039139880803100506

Cited by 57 publications

(49 citation statements)

References 21 publications

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“…Ultrafiltration during the PET depends on the balance between the different forces acting across the peritoneal capil- 2 . The sodium in the ultrafiltrate was the difference between the sodium instilled and that recovered at the end of the PET.…”

Section: Discussionmentioning

confidence: 99%

“…Patients treated with hemodialysis are typically assessed by small solute clearances (Kt/V) (1) and interdialytic weight gains (2). Although peritoneal dialysis patients are also assessed by small solute clearances (3), failure to control volume overload, particularly because of ultrafiltration failure, is more likely to lead to treatment failure, and fluid overload is also associated with an increased risk of patient mortality (4).…”

mentioning

confidence: 99%

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Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Davenport

Willicombe

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The peritoneal equilibration test (PET) was developed some 25 yr ago and has been used to help prescribe peritoneal dialysis. However, PET is affected by several factors, including diabetes and inflammation. It was speculated that extracellular fluid overload would increase PET ultrafiltration volumes, and therefore the usefulness of the PET in routine clinical practice was audited.Design, setting, participants, & measurements: Data from 211 consecutive patients attending a university teaching hospital for a standard PET who had multifrequency bioimpedance performance were analyzed to determine which factors affected net PET ultrafiltration volumes.Results: Net PET ultrafiltration volume was independent of gender, age, diabetes, residual renal function, peritoneal dialysis prescriptions (modes and dialysates), extracellular fluid volume, or C-reactive protein (CRP). There was an inverse regression with serum albumin and sodium on multiple logistical regression analysis (F ‫؍‬ 13.4, P < 0.001 and F ‫؍‬ 10.1, P ‫؍‬ 0.001, respectively) and a positive regression with 24-h net peritoneal ultrafiltration volumes (F ‫؍‬ 15.5, P < 0.001). As expected, there was a strong correlation with net sodium losses (r ‫؍‬ 0.99, P < 0001).Conclusions: It was found that PET test ultrafiltration volume in routine clinical practice was not affected by CRP, hyperglycemia, or extracellular fluid volume overload. Ultrafiltration volumes were increased in those patients with reduced serum sodium and albumin, most likely because of inflammation and protein malnutrition.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Davenport

Willicombe

2009

Clinical Journal of the American Society of Nephrology

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“…Therefore, the lower the dialysate (compared to the patient's sodium) the better the IDWG and BP control. In the two audits, patients dialyzing against a relatively lower sodium concentration had less IDWG (Davenport 2006(Davenport , 2008. In the initial study, lower dialysate sodium was correlated with an improvement in BP control (defined as decrease in pre-dialysis blood pressure or number of antihypertensives prescribed).…”

Section: Retrospective Studiesmentioning

confidence: 98%

Sodium and Hemodialysis

Gembala¹,

Kumar²

2011

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice

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“…Firstly, lower dialysate [Na+] is associated with lower inter-dialytic weight gain (IDWG) [23-35] and consequently less fluid removal during dialysis, factors which are protective against IDH [36] . Secondly, elevation in plasma [Na+] is likely to occur during treatment with a higher dialysate [Na+].…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of the myocardial microinjury and cardiac remodeling extension study in the sodium lowering in dialysate trial (Mac-SoLID study)

et al. 2014

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BackgroundThe Sodium Lowering in Dialysate (SoLID) trial is an ongoing a multi-center, prospective, randomised, single-blind (assessor), controlled, parallel assignment clinical trial, enrolling 96 home and self-care hemodialysis (HD) patients from 7 centers in New Zealand. The trial will evaluate the hypothesis that lower dialysate [Na+] during HD results in lower left ventricular (LV) mass. Since it’s inception, observational evidence has suggested increased mortality risk with lower dialysate [Na+], possibly due to exacerbation of intra-dialytic hypotension and subsequent myocardial micro-injury. The Myocardial Micro-injury and Cardiac Remodeling Extension Study in the Sodium Lowering In Dialysate Trial (Mac-SoLID study) aims to determine whether lower dialysate [Na+] results in (i) increased levels of high-sensitivity Troponin T (hsTnT), a well-established marker of intra-dialytic myocardial micro-injury in HD populations, and (ii) increased fixed LV segmental wall motion abnormalities, a marker of recurrent myocardial stunning and micro-injury, and (iii) detrimental changes in LV geometry due to maladaptive homeostatic mechanisms.Methods/designThe SoLID trial and the Mac-SoLID study are funded by the Health Research Council of New Zealand. Key exclusion criteria: patients who dialyse > 3.5 times per week, pre-dialysis serum sodium <135 mM, and maintenance haemodiafiltration. In addition, some medical conditions, treatments or participation in other dialysis trials that contraindicate the study intervention or confound its effects, will be exclusion criteria. The intervention and control groups will receive dialysate sodium 135 mM and 140 mM respectively, for 12 months. The primary outcome measure for the Mac-SOLID study is repeated measures of [hsTnT] at 0, 3, 6, 9, and 12 months. The secondary outcomes will be assessed using cardiac magnetic resonance imaging (MRI), and comprise LV segmental wall motion abnormality scores, LV mass to volume ratio and patterns of LV remodeling at 0 and 12 months.DiscussionThe Mac-SoLID study enhances and complements the SoLID trial. It tests whether potential gains in cardiovascular health (reduced LV mass) which low dialysate [Na+] is expected to deliver, are counteracted by deterioration in cardiovascular health through alternative mechanisms, namely repeated LV stunning and micro-injury.Trial registrationAustralian and New Zealand Clinical Trials Registry number: ACTRN12611000975998.

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The Importance of Dialysate Sodium Concentration in Determining Interdialytic Weight Gains in Chronic Hemodialysis Patients: The PanThames Renal Audit

Abstract: (Int J Artif Organs 2008; 31: 411-7)

Cited by 57 publications

References 21 publications

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Sodium and Hemodialysis

Rationale and design of the myocardial microinjury and cardiac remodeling extension study in the sodium lowering in dialysate trial (Mac-SoLID study)

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