Treatment of Severe Hyponatremia in Patients With Kidney Failure: Role of Continuous Venovenous Hemofiltration With Low-Sodium Replacement Fluid

Yessayan, Lenar; Yee, Jerry; Frinak, Stanley; Szamosfalvi, Balázs

doi:10.1053/j.ajkd.2014.01.451

Cited by 45 publications

(60 citation statements)

References 21 publications

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“…However, the relative hypertonicity of this solution compared to our patient's serum sodium concentration increased the risk of rapid correction and osmotic demyelination syndrome . Yessayan et al eloquently describe a method to modify the dialysate and replacement solutions for CRRT by adding or exchanging volumes of the commercially prepared solution with sterile water . Furthermore, they provide a simple set of Na + kinetic equations which are easy to apply in clinical practice that can be used to estimate sodium concentration at the end of treatment .…”

Section: Discussionmentioning

confidence: 99%

“…Yessayan et al eloquently describe a method to modify the dialysate and replacement solutions for CRRT by adding or exchanging volumes of the commercially prepared solution with sterile water . Furthermore, they provide a simple set of Na + kinetic equations which are easy to apply in clinical practice that can be used to estimate sodium concentration at the end of treatment . It was not feasible to modify the commercially prepared CRRT solutions due to logistic issues at our institution, thus we chose conventional HD given the patient's hemodynamic stability.…”

Section: Discussionmentioning

confidence: 99%

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Acute hemodialysis in a young man with severe symptomatic hyponatremia and kidney injury

Courteau

Khoury

Michel

et al. 2018

Hemodialysis International

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A 35-year-old man presented with severe hypo-osmolar hyponatremia (serum sodium 99 mmol/L), profound nonoliguric renal failure (serum creatinine 1240 μmol/L), and nephrotic range proteinuria. Computed tomography of the abdomen revealed nephromegaly and no obstruction. The patient was admitted to the intensive care unit (ICU) and conventional hemodialysis was initiated. To avoid rapid sodium correction, we prescribed concurrent dialysate flow, a low dialysate sodium concentration, a small surface area dialyzer, and a low blood flow rate. We infused dextrose 5% water into the venous return line and adjusted the infusion rate according to hourly sodium concentration. The rate of sodium correction was 7.7 mmol/day over the first 3 days of admission. A subsequent renal biopsy revealed focal segmental glomerulosclerosis and interstitial infiltration with extranodal NK/T-cell lymphoma nasal type. The patient died of massive lower gastrointestinal bleeding secondary to lymphomatous involvement day 19 in the ICU. In the setting of acute kidney injury requiring renal replacement therapy and concomitant severe hyponatremia, it is challenging to avoid overcorrection of serum sodium. We describe several key prescription modifications to conventional hemodialysis, factors that affect sodium diffusion at the level of the dialyzer membrane, and the importance of frequent laboratory monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute hemodialysis in a young man with severe symptomatic hyponatremia and kidney injury

Courteau

Khoury

Michel

et al. 2018

Hemodialysis International

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“…It was thought that ultrafiltration, in preference to haemodialysis, or the more commonly used haemodiafiltration, would allow tighter control over electrolyte balance, an approach supported in the literature 17. Ultrafiltration, however, requires the use of replacement fluid, and there are no commercial fluids which are hypotonic with low concentrations of sodium.…”

Section: Discussionmentioning

confidence: 99%

Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum

Secombe¹,

Milne

2016

BMJ Case Reports

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Hyponatraemia-induced rhabdomyolysis is a rare, but reported phenomenon, particularly in patients with chronic schizophrenia on depot antipsychotics prone to psychogenic polydipsia. To the best of our knowledge, there are no reported cases of hyponatraemia-induced rhabdomyolysis complicated by oligo-anuric acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). The initiation of CRRT is complicated in severe hyponatraemia, predominantly due to the need to avoid rapid changes in tonicity associated with rapid changes in sodium. We report a case of severe hyponatraemia (104 mmol/L) complicated by oligo-anuric rhabdomyolysis-induced AKI and our management of the renal prescription.

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“…15 Sodium and potassium total content and total body water (TBW) volume changes derived from the gain or loss of fluids non-isotonic to [Na] Din were included in the calculations and represented by the artificial kinetic term, sodium generation per hour, G averaged over a 24-hour period. 15 Sodium and potassium total content and total body water (TBW) volume changes derived from the gain or loss of fluids non-isotonic to [Na] Din were included in the calculations and represented by the artificial kinetic term, sodium generation per hour, G averaged over a 24-hour period.…”

Section: Crrt Therapymentioning

confidence: 99%

High sodium continuous veno‐venous hemodialysis with regional citrate anticoagulation and online dialysate generation in patients with acute liver failure and cerebral edema

Hamdi

Yessayan

Yee

et al. 2017

Hemodialysis International

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We describe a novel approach for delivering continuous osmotherapy to patients with acute liver failure, renal failure, and cerebral edema. In comparison to standard therapy, the described modality enables precise titration of serum sodium without undesirable fluctuations in extracellular fluid volume. A particular advantage is zero delivery of citrate to this vulnerable group of patients with acute liver failure.

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Treatment of Severe Hyponatremia in Patients With Kidney Failure: Role of Continuous Venovenous Hemofiltration With Low-Sodium Replacement Fluid

Cited by 45 publications

References 21 publications

Acute hemodialysis in a young man with severe symptomatic hyponatremia and kidney injury

Acute hemodialysis in a young man with severe symptomatic hyponatremia and kidney injury

Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum

High sodium continuous veno‐venous hemodialysis with regional citrate anticoagulation and online dialysate generation in patients with acute liver failure and cerebral edema

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