Severe Hyponatremia and Continuous Renal Replacement Therapy: Safety and Effectiveness of Low-Sodium Dialysate

• Published in: Kidney medicine Vol. 2; no. 4; pp. 437 - 449
• Main Authors: Tandukar, Srijan, Kim, Catherine, Kalra, Kartik, Verma, Siddharth, Palevsky, Paul M., Puttarajappa, Chethan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2020; Elsevier
• Subjects: acute kidney injury; continuous renal replacement therapy; end stage renal disease; Hyponatremia; low sodium CRRT; low sodium dialysate; Original Research; end stage renal disease; acute kidney injury; Hyponatremia; low sodium CRRT; low sodium dialysate; continuous renal replacement therapy
• ISSN: 2590-0595; 2590-0595
• DOI: 10.1016/j.xkme.2020.05.007

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. 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. 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. 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 27mL/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. Key limitations were small sample size and lack of a control group. 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. [Display omitted]