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Sodium handling in pediatric patients on maintenance dialysis

Fabio Paglialonga1, Claus Peter Schmitt2

  • 1Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabio.paglialonga@policlinico.mi.it.

Pediatric Nephrology (Berlin, Germany)
|May 6, 2023
PubMed

Insights

Pediatric patients with chronic kidney disease stage 5 on dialysis (CKD 5D) face high cardiovascular risks from sodium overload. Optimizing dialysis sodium removal is key to managing this risk without causing adverse effects.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Cardiovascular Health

Background:

  • Pediatric patients with chronic kidney disease stage 5 on dialysis (CKD 5D) have a high risk of cardiovascular disease.
  • Sodium overload is a significant contributor to cardiovascular risk in this population, causing both volume-dependent and independent toxicity.
  • Dietary sodium restriction is challenging, and impaired urinary sodium excretion necessitates effective dialytic sodium removal.

Purpose of the Study:

  • To review current knowledge on intradialytic sodium handling in pediatric CKD 5D patients.
  • To explore strategies for optimizing dialytic sodium removal in hemodialysis (HD) and peritoneal dialysis (PD).
  • To balance the need for sodium removal with the risk of volume depletion and hypotension.

Main Methods:

  • Review of existing literature on intradialytic sodium management in pediatric dialysis.
  • Analysis of sodium handling mechanisms during hemodialysis and peritoneal dialysis.
  • Evaluation of strategies such as lower dialysate sodium and adapted PD parameters.

Main Results:

  • Lower dialysate sodium prescriptions show promise for salt-overloaded children on HD.
  • Individualized adaptation of dwell time, volume, and icodextrin use can enhance sodium removal in PD.
  • Careful management of intradialytic sodium removal is crucial to prevent complications like hypotension.

Conclusions:

  • Optimizing dialytic sodium removal is critical for reducing cardiovascular risk in pediatric CKD 5D patients.
  • Tailored approaches to hemodialysis and peritoneal dialysis sodium management are necessary.
  • Further research into individualized sodium management strategies is warranted.

Keywords:
ChildrenHemodialysisPeritoneal dialysisSaltSodium

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