Related Experiment Video
Updated: May 20, 2025
Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis
Published on: July 19, 2018
Associations Between Serum Sodium, Peritoneal Dialysis-Associated Peritonitis, and Mortality in the Peritoneal
Isaac Teitelbaum1, Junhui Zhao2, Charlotte Tu2
1Division of Kidney Diseases and Hypertension, Department of Medicine, School of Medicine, University of Colorado Hospital, Aurora, Colorado.
Rationale & Objective:
The clinical consequences of hyponatremia among patients receiving peritoneal dialysis (PD) are poorly understood. This study sought to evaluate the association of variations in serum sodium with peritoneal dialysis-associated peritonitis and death.
Study Design:
Multicenter observational cohort study.
Settings & Participants:
23,707 participants in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) in 8 countries between 2014 and 2022 with a serum sodium measure available at study enrollment.
Predictor:
Serum sodium categories (<135, 135-137, 138-139, 140-141, ≥142 mEq/L) at study enrollment.
Outcome:
Time to first peritonitis episode and all-cause mortality.
Analytical Approach:
Cause-specific hazards models adjusted for demographic, comorbidity, and treatment characteristics. Secondary analyses using average serum sodium levels over time and evaluation of modification of the association between serum sodium and study outcomes by use of icodextrin as well as patient characteristics and PD modality.
Results:
Compared to a serum sodium of 140-141 mEq/L (n=5,065), those with a sodium of<135 mEq/L (n=3,601) had longer dialysis vintage and were more likely to have diabetes and use icodextrin. Across serum sodium categories, there were no differences in the adjusted peritonitis risks. Compared to individuals with a sodium of 140-141 mEq/L, those with a sodium of<135 mEq/L (adjusted hazard ratio [AHR], 1.45 [95% CI, 1.29-1.63]), a sodium of 135-137 mEq/L (AHR, 1.26 [95% CI, 1.13-1.42]), and a sodium≥142 mEq/L (AHR, 1.16 [95% CI, 1.03-1.30]) were all associated with higher mortality. Associations between serum sodium and mortality were similar across all patient characteristic and PD modality subgroups. Peritonitis risk was not detectably different across serum sodium categories regardless of treatment with icodextrin.
Limitations:
Lack of standardization/validation of serum sodium measures across sites; icodextrin use was limited to a subset of patients.
Conclusions:
Variations in serum sodium were associated with death but not peritonitis risk. Future studies are needed to understand the mechanisms underpinning these associations and whether modification of serum sodium would improve outcomes among those receiving PD.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:24Renal Tubule and Collecting Duct
Proximal Convoluted Tubule (PCT):
The PCT is the initial segment of the renal tubule, extending from the Bowman's capsule that encloses the glomerulus. Its convoluted structure and microvilli-lined cells increase the surface area for reabsorption. The PCT reabsorbs glucose, amino acids, sodium, and water from the filtrate, ensuring essential...
01:22Heart Failure Drugs: Diuretics
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...