Severe Hyponatremia and Continuous Renal Replacement Therapy: Safety and Effectiveness of Low-Sodium DialysatePlain-Language Summary

Kidney Medicine

Catherine Kim¹  Kartik Kalra²  Siddharth Verma³  Paul M. Palevsky³  Chethan Puttarajappa³  Srijan Tandukar⁴ 

[1] Address for Correspondence: Srijan Tandukar, MD, 2751 Albert L. Bicknell Dr, Ste 4A, Shreveport, LA 71103.;Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA;Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA;Willis-Knighton Medical Center, Shreveport, LA;

关键词: Hyponatremia;    continuous renal replacement therapy;    acute kidney injury;    end stage renal disease;    low sodium dialysate;    low sodium CRRT;   

DOI  :  

来源: DOAJ

【 摘 要 】

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 <24 hours. Results: The 19 patients included in the study had a mean age of 56 years, 11 (58%) were men, and 15 (79%) were white. The initial mean plasma sodium level was 121 mEq/L and the initial CRRT effluent dose was 27 mL/kg/h. Only 2 (11%) patients had an increase in plasma sodium concentration > 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.

【 授权许可】

Unknown