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Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study

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Abstract

Background

Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis.

Methods

Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa). Primary outcomes were systolic blood pressure and diastolic blood pressure standard deviation scores (SBP and DBP SDS), obtained by 24-h ambulatory blood pressure monitoring or office BP according to age, and interdialytic weight gain (IDWG).

Results

Forty-one patients (31 HD), with a median age of 13.3 (IQR 5.2) years, were enrolled. Twelve patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.7) mEq/kg/day. Median total Na intake was 1.5 (1.1) mEq/kg/day, corresponding to 60.6% of the maximum recommended daily intake for healthy children. Median uNa and sNaB were 0.6 (1.8) mEq/kg/day and 0.9 (1.7) mEq/kg/day, respectively. The strongest independent predictor of sNaB in the cohort was urine output. In patients receiving HD, sNaB correlated with IDWG, pre-HD DBP, and first-hour refill index, a volume index based on blood volume monitoring. sNaB was the strongest predictor of IDWG in multiple regression analysis (β = 0.63; p = 0.005). Neither SBP SDS nor DBP SDS correlated with sNaB.

Conclusions

Na intake is higher than uNa in children on dialysis, and medications may be an important source of Na. sNaB is best predicted by urine output in the population, and it is a significant independent predictor of IDWG in children on HD.

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Data availability

Data available on request.

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Acknowledgements

We thank all the members of the European Pediatric Dialysis Working Group (EPDWG) for their support of the study: G. Ariceta, Hospital Vall d’Hebron, Barcelona, Spain; C. Aufricht, Medical University of Vienna, Vienna, Austria; T. Holtta, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; G. Klaus, University Children’s Hospital, Marburg, Germany; B. Ranchin, Hospices Civils de Lyon and Université Lyon, Lyon, France; C.P. Schmitt, University of Heidelberg, Heidelberg, Germany; E. Snauwaert, University Hospital Ghent, Ghent, Belgium; C. Stefanidis, Mitera Children’s Hospital, Athens, Greece; J. Vande Walle, University Hospital Ghent, Ghent, Belgium; S. Stabouli, Aristotle University, Thessaloniki, Greece; E. Verrina, Giannina Gaslini Children’s Hospital, Genoa, Italy; E. Vidal, University Hospital of Padova, Padua, Italy; K. Vondrak, University Hospital Motol, Prague, Czech Republic; and A. Zurowska, Medical University of Gdansk, Gdansk, Poland.

Funding

The study was supported by an unrestricted grant provided by the European Society for Paediatric Nephrology. ACG received a 2-month fellowship grant for this study from the European Rare Kidney Disease Reference Network (ERKNet) on behalf of the European Joint Programme on Rare Diseases (EJP-RD) Research Mobility Fellowship Programme.

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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

    Fabio Paglialonga, Silvia Consolo & Alberto Edefonti

  2. University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK

    Rukshana Shroff & Louise McAlister

  3. Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland

    Ilona Zagozdzon & Aleksandra Skibiak

  4. Department of Pediatric Nephrology, Gazi University, Ankara, Turkey

    Sevcan A. Bakkaloglu & Burcu Yazicioglu

  5. Department of Pediatric Nephrology, Hopital de Hautepierre, Strasbourg, France

    Ariane Zaloszyc

  6. Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania

    Augustina Jankauskiene

  7. Department of Pediatric Nephrology, University Hospital Vall d’Hebron, Barcelona, Spain

    Alejandro Cruz Gual

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

    Maria Rosa Grassi

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

    Giuseppe Puccio

Authors
  1. Fabio Paglialonga
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  10. Louise McAlister
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  14. Alberto Edefonti
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  15. Gema Ariceta
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  18. Guenter Klaus
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  26. Enrico Vidal
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on behalf of the European Pediatric Dialysis Working Group (EPDWG)

Contributions

R. S., I. Z., S. A. B., A. Z., A. J., S. C., M. R. G., L. M., A. S., and B. Y. contributed patients to the study. F. P. is the principal investigator. F. P., A. E., and S. C. designed the study. G. P. performed the statistical analyses. F. P., R. S., and A. E. drafted the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabio Paglialonga.

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Paglialonga, F., Shroff, R., Zagozdzon, I. et al. Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study. Pediatr Nephrol 38, 3389–3399 (2023). https://doi.org/10.1007/s00467-023-05932-y

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