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

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Abstract

Background

The optimal dialysate sodium concentration (dNa) in children on hemodialysis (HD) is unknown. The aim of this study was to compare the effect on interdialytic weight gain (IDWG) and blood pressure (BP) of a low (135 mmol/l) and standard dNa (138 mmol/l) in children and young adults on maintenance HD.

Methods

This prospective single-blind randomized crossover study consisted of a randomized sequence of two phases: “standard dNa” of 138 mmol/L and “low dNa” of 135 mmol/L. Each phase lasted 4 weeks. Inclusion criteria were age < 25 years, hypertension, pre-HD serum Na (sNa) ≥ 130 mmol/L, and occurrence of symptoms in less than 25% of sessions. Primary outcomes were pre-HD systolic and diastolic BP and IDWG.

Results

Fifteen patients were recruited, mean age 17.8 ± 4.4 years. Pre-HD SBP and DBP were not different between the two treatments. Mean IDWG was significantly lower with low dNa than with standard dNa: 2.12 ± 1.39% vs. 2.77 ± 1.53%, respectively (p = 0.008). The first-hour refill index (a volume index based on blood-volume monitoring) was significantly lower with dNa 135 mmol/L (p = 0.018). The mean Na gradient (dNa–sNa) was − 2.53 ± 2.4 mmol/L with dNa 135 mmol/L and 0.17 ± 2.8 mmol/L with dNa 138 mmol/L (p = 0.0001). The incidence of symptomatic sessions was similar (1.0% vs. 1.0%).

Conclusions

In a selected population of hypertensive pediatric and young adult HD patients, a dNa of 135 mmol/L was associated with a significant reduction of IDWG compared with a dNa of 138 mmol/L. Furthermore, long-term studies are needed to investigate the effect of lowering dNa on BP.

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Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy

    Olga Caporale, Silvia Consolo, Francesca S. Grassi, Giovanni Montini & Fabio Paglialonga

  2. Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy

    Maria R. Grassi & Giovanni Montini

  3. Department of Sciences for Health Promotion, University of Palermo, Palermo, Italy

    Giuseppe Puccio

Authors
  1. Olga Caporale
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  2. Silvia Consolo
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  3. Francesca S. Grassi
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  4. Maria R. Grassi
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  5. Giuseppe Puccio
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  6. Giovanni Montini
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  7. Fabio Paglialonga
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Contributions

OC, SC, FSG, and MRG contributed data to the study. OC is the principal investigator. OC, S,C and FP designed the study. GP performed the statistical analyses. OC and FP drafted the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabio Paglialonga.

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Caporale, O., Consolo, S., Grassi, F.S. et al. Low dialysate sodium in children and young adults on maintenance hemodialysis: a prospective, randomized, crossover study. Pediatr Nephrol 38, 1599–1607 (2023). https://doi.org/10.1007/s00467-022-05792-y

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  • DOI: https://doi.org/10.1007/s00467-022-05792-y

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