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Association of predialysis serum sodium level with fluid status in patients on maintenance hemodialysis

  • Nephrology - Original Paper
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Abstract

Purpose

The ability to maintain sodium and water homeostasis is impaired in patients with end-stage renal disease (ESRD), leading to hyponatremia and fluid overload. The aim of this study was to evaluate the association between serum sodium level and body fluid status in patients on maintenance hemodialysis (HD).

Methods

This was a prospective observational study on patients with ESRD and who were on maintenance HD between June and November 2018. Assessment of body fluid status using bioimpedance spectroscopy and measurement of serum sodium level were conducted simultaneously predialysis. The association of fluid status with predialysis sodium level was analyzed.

Results

Sixty-two patients were enrolled in the study group. Compared with patients with predialysis normonatremia, those with predialysis hyponatremia had higher levels of blood urea nitrogen, serum potassium, phosphate, normalized protein catabolic rate, and interdialytic weight gain (IDWG) (p < 0.05). The correlations of predialysis sodium level with chronic fluid status, such as fluid overload, were not significant. Logistic regression analysis found significant association of IDWG with predialysis hyponatremia.

Conclusion

Predialysis hyponatremia was associated with increased IDWG. The substantial variation in serum sodium levels, regardless of fluid status, indicated the complex relationship between sodium and water balance in patients on maintenance HD.

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Funding

This study was supported in part by a grant from the Armed Forces Taoyuan General Hospital (AFTYGH-10711).

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, No. 168, Jhongsing Road, Longtan, Taoyuan, 32551, Taiwan

    Wen-Fang Chiang, Po-Jen Hsiao, Kun-Lin Wu & Jenq-Shyong Chan

  2. Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Wen-Fang Chiang, Po-Jen Hsiao, Kun-Lin Wu & Jenq-Shyong Chan

  3. School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Wen-Fang Chiang, Po-Jen Hsiao, Kun-Lin Wu & Jenq-Shyong Chan

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  1. Wen-Fang Chiang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by W-FC, P-JH and K-LW. The first draft of the manuscript was written by W-FC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jenq-Shyong Chan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was performed in accordance with Declaration of Helsinki guidelines on the ethical principles for medical research involving human subjects and was approved by the Institutional Review Board of the Tri-Service General Hospital (TSGHIRB No. 1-107-05-034).

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Informed consent was obtained from all individual participants included in the study.

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Chiang, WF., Hsiao, PJ., Wu, KL. et al. Association of predialysis serum sodium level with fluid status in patients on maintenance hemodialysis. Int Urol Nephrol 52, 1571–1579 (2020). https://doi.org/10.1007/s11255-020-02521-y

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  • DOI: https://doi.org/10.1007/s11255-020-02521-y

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