ESPN 54th Annual Meeting

ESPN 2022


 
LOW DIALYSATE SODIUM CONCENTRATION IN PEDIATRIC AND YOUNG ADULT PATIENTS ON MAINTENANCE HEMODIALYSIS: A PROSPECTIVE, RANDOMIZED, CROSSOVER STUDY
OLGA CAPORALE 1 SILVIA CONSOLO 1 FRANCESCA SOFIA GRASSI 1 GIUSEPPE PUCCIO 2 GIOVANNI MONTINI 1 FABIO PAGLIALONGA 1

1- PEDIATRIC NEPHROLOGY, DIALYSIS AND TRANSPLANT UNIT, FONDAZIONE IRCCS CA GRANDA OSPEDALE MAGGIORE POLICLINICO, MILAN, ITALY
2- DEPARTMENT OF SCIENCES FOR HEALTH PROMOTION, UNIVERSITY OF PALERMO, ITALY
 
Introduction:

The optimal dialysate sodium (dNa) concentration in patients on maintenance hemodialysis (HD) is still debated, especially in pediatrics. Aim of our study was to compare the effect on blood pressure (BP) and interdialytic weight gain (IDWG) of a dNa reduction to 135 mEq/l vs the standard concentration (138 mEq/l) in pediatric and young adult patients on chronic HD.

Material and methods:

This single-center, prospective, randomized, crossover study consisted in a randomized sequence of two study phases: “standard dNa” of 138 mmol/L and “low dNa” of 135 mmol/L. Each study phase lasted 4 weeks and was preceded by a 2-week washout-period. Inclusion criteria were age <25 years, pre-HD serum Na (sNa) ≥ 130 mmol/L, hypertension, low incidence of intradialytic events. Study endpoints were: pre- and post-HD systolic and diastolic BP (SBP and DBP), IDWG as percentage of body weight, first-hour refill index (a BVM-based index of pre-HD fluid overload), incidence of symptomatic sessions (hypotension, cramps, vomiting), pre- and postHD sNa.

Results:

Fifteen patients were recruited, mean age 17.8 ± 4.4 years (8 patients <18years). Pre- and post-HD SBP and DBP were not significantly different between the two treatments. Mean IDWG was significantly lower in the dNa 135 than in the dNa 138 phase: 2.12±1.39% vs 2.77±1.53% (p=0.008) with a mean reduction of 22.7%. The Refill Index was significantly lower with dNa of 135 mmol/L (p= 0.018). The mean sodium gradient (dNa-sNa) with dNa 138 and 135 mmol/L was 0.17±2.8 and 2.53±2.4 mmol/L respectively (p=0.0001). The incidence of symptomatic sessions was similar (1.0% vs 1.0%).

Conclusions:

In a selected population of non-hypotension prone pediatric and young adult HD patients, lowering dNa to 135 mmol/L is associated with a significant reduction in IDWG over a 1-month period. Further longer-term studies are needed to investigate the effect of lowering dNa on BP in this population.