ESPN 54th Annual Meeting

ESPN 2022


 
SODIUM BALANCE IN CHILDREN ON DIALYSIS: A MULTICENTER PROSPECTIVE STUDY FROM THE EUROPEAN PEDIATRIC DIALYSIS WORKING GROUP
FABIO PAGLIALONGA 1 Rukshana Shroff 2 Ilona Zagozdzon 3 Sevcan Bakkaloglu 4 Ariane Zaloszyc 5 Augustina Jankauskiene 6 Alejandro Cruz 7 Silvia Consolo 1 Alberto Edefonti 1

1- PEDIATRIC NEPHROLOGY, DIALYSIS AND TRANSPLANT UNIT, FONDAZIONE IRCCS CA GRANDA OSPEDALE MAGGIORE POLICLINICO, MILAN, ITALY
2- University College London, Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
3- Department Paediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
4- Gazi University Hospital, Ankara, Turkey
5- Department of Pediatric Nephrology, Hopital de Hautepierre, Strasbourg, France
6- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
7- Department of Pediatric Nephrology, Hospital Vall D’Hebron, Barcelona, Spain
 
Introduction:

We aimed to assess the sodium balance (NaB) and its clinical correlates in children receiving maintenance dialysis. 

Material and methods:

We recruited patients < 18 years undergoing thrice weekly hemodialysis (HD) or automated peritoneal dialysis (PD) in the European Pediatric Dialysis Working Group (EPDWG) centers.  NaB was calculated from enteral Na intake (eNa), obtained by a three-day dietary diary, medication-related Na intake, and urinary Na losses (uNa), measured by 24-h urine collection. Blood pressure (BP) was measured by 24h-ABPM in children >5 years and median office BP in younger patients. Percentage interdialytic weight gain (IDWG), pre-HD office BP, and first-hour refill index (an index of pre-HD fluid overload based on BVM) were assessed in HD patients, ultrafiltration (UF/kg/session) in PD children.

Results:

41 patients (31 HD, 10 PD), median age 13.3 (10.7-15.8) years, were recruited. Median eNa was 1.3 (1.0-2.0) mEq/kg/day; 12 patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.5-1.1) mEq/kg/day (=40% of the total Na intake in this group). Median total Na intake was 1.5 (1.2-2.3) mEq/kg/day, corresponding to 60.6% (40.9-80.2%) of the maximum RDI for healthy children, and uNa 0.6 (0.1-1.8) mEq/kg/day. Median NaB was +0.88 (-0.05 to +1.7) mEq/kg/day.  NaB negatively correlated with age, urine output and plasma Na; neither systolic nor diastolic BP SDS significantly correlated with NaB. In HD patients, NaB significantly correlated with IDWG (r2=0.59; p<0.0001), preHD diastolic BP (r2= 0.30; p=0.001), first-hour refill index (r2= 0.57; p=0.002). A multivariable analysis including age and urine output demonstrated that NaB was the only significant predictor of IDWG (b=0.85, p<0.0001). A tendency towards a positive correlation between NaB and UF/kg was found in PD patients.

Conclusions:

 NaB is a significant and independent predictor of IDWG in children on HD. The lack of correlation between NaB and blood pressure deserves further investigation.