Key result
Use of low-sodium dialysate (119 or 126 mEq/L) during continuous renal replacement therapy safely limited overly rapid sodium correction, with only 11% of patients exceeding a 6 mEq/L increase in 24 hours.
Why the study?
In patients with severe hyponatremia and acute kidney injury or end-stage kidney disease, CRRT using standard-sodium fluids may cause excessively rapid sodium correction.
Does low-sodium dialysate and replacement fluid safely control the rate of plasma sodium correction in patients with severe hyponatremia undergoing CRRT?
Cohort (n=19)
No
Does low-sodium dialysate and replacement fluid safely control the rate of plasma sodium correction in patients with severe hyponatremia undergoing CRRT?
The use of low-sodium dialysate and replacement fluids during CRRT is a safe and effective strategy to prevent overly rapid correction of plasma sodium in patients with severe hyponatremia.
May support low-sodium dialysate in CRRT for hyponatremia; hypothesis-generating and requires randomized confirmation.
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.
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Tandukar et al. (2020) conducted a cohort in Severe hyponatremia with acute kidney injury or end-stage kidney disease (n=19). Low-sodium dialysate and replacement fluids was evaluated on Proportion of patients who had an increase in plasma sodium level > 6 mEq/L in 24 hours. Use of low-sodium dialysate (119 or 126 mEq/L) during continuous renal replacement therapy safely limited overly rapid sodium correction, with only 11% of patients exceeding a 6 mEq/L increase in 24 hours.
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