Low dialysate sodium in children and young adults on maintenance hemodialysis: a prospective, randomized, crossover...

Area of Science:

• Nephrology
• Pediatric Nephrology
• Dialysis Therapy

Background:

• The optimal dialysate sodium concentration (dNa) for children undergoing hemodialysis (HD) remains undetermined.
• Current practices often use a standard dNa of 138 mmol/L, but its efficacy and safety in pediatric populations require further investigation.

Purpose of the Study:

• To compare the effects of low (135 mmol/L) versus standard (138 mmol/L) dNa on interdialytic weight gain (IDWG) and blood pressure (BP).
• To evaluate fluid management and hemodynamic parameters in pediatric and young adult HD patients using different dNa levels.

Main Methods:

• A prospective, single-blind, randomized crossover study involving 15 pediatric and young adult HD patients.
• Patients were assigned to sequential 4-week phases of either 135 mmol/L or 138 mmol/L dNa.
• Primary outcomes included pre-HD systolic and diastolic blood pressure (BP) and IDWG.

Main Results:

• Mean IDWG was significantly lower with 135 mmol/L dNa (2.12%) compared to 138 mmol/L dNa (2.77%) (p=0.008).
• The first-hour refill index, a measure of fluid status, was also significantly lower with 135 mmol/L dNa (p=0.018).
• No significant differences in pre-HD BP or the incidence of symptomatic sessions were observed between the two dNa concentrations.

Conclusions:

• A dialysate sodium concentration of 135 mmol/L is associated with reduced IDWG in hypertensive pediatric and young adult HD patients.
• Further long-term studies are necessary to fully elucidate the impact of lower dNa on blood pressure control in this demographic.
• The findings support the consideration of lower dNa concentrations for improved fluid management in select pediatric HD patients.