Validity and reliability of the Horiba C-122 compact sodium analyzer in sweat samples of athletes

Accurate sodium replacement during prolonged exercise is possible when sweat rate and sweat sodium content are directly measured. Few athletes have access to sweat sodium content measurement, as the equipment needed to perform such analyzes is costly, laboratory-based or requires technical skills. Using 70 sweat samples collected in 24 athletes from 3 anatomical sites, this study determined the reliability [single-trial and inter-day (7 samples over 3 days)] and validity (instrument error) of a pocket-sized, easy-to-use and low cost sodium analyzer (Horiba C-122, Kyoto, Japan) against reference values of an ion chromatograph, the 883 Basic IC plus (Metrohm AG, Herisau, Switzerland). The Horiba C-122 showed high single-trial reliability with an intraclass correlation coefficient (ICC) of 0.997, a typical error of measurement (EM) of 1.77 mmol/L and a coefficient of variation (CV) of 3.73%. As expected, the reliability of the 883 Basic IC plus was superior to that of the Horiba C-122 (ICC: 0.999; typical EM: 0.70 mmol/L; CV: 1.52%). The Horiba’s C-122 inter-day reliability was high (ICC: 1.00; typical EM: 0.35 mmol/L). An ICC of 0.975 indicates there was a strong relationship between results provided by both analyzers. Compared with reference values, the Horiba C-122 demonstrated a mean bias of 1.71 mmol/L, a pure EM of 7.52 mmol/L and 68% limits of agreement ranging from -5.81 to 9.23 mmol/L. We propose that the Horiba C-122 is sufficiently reliable to be used under field conditions where some degree of imprecision is acceptable, but not for research purposes where high accuracy is required.