#1895 Sodium balance in hemodialysis and hemodiafiltration: real-world insights from spanish clinics

Le résumé fourni par la source

Abstract Background and Aims Although nephrologists have been prescribing the sodium concentration in dialysate since the beginnings of the dialysis treatment, optimal sodium concentration in dialysis fluid remains unclear. Most studies have analyzed fixed concentrations. However, serum sodium concentrations in patients are not fixed, so this type of analysis combines patients with the same sodium prescription but different sodium balances during the dialysis session. In this study, we present data on sodium diffusive balance with the Sodium Module (6008 Caresystem, FME). Its relationship with comorbidities, treatment modality (hemodialysis (HD)/hemodiafiltration (HDF)), sodium prescription and further laboratory values were assessed. Method This retrospective study uses real-world data from adult dialysis patients treated at two NephroCare Clinics in Spain (July 2018–March 2022). Data were collected from the European Clinical Database (EuCliD®). Sodium balance removal was calculated as NaCl removed via diffusion (excluding ultrafiltration), maintaining the sodium prescribed by the attending physician. We evaluated the association between sodium balance, baseline comorbidities (diabetes, hypertension, cardiovascular disease) and modality (HD, HDF). Diffusive sodium balance was analyzed as a continuous variable and categorized into three classes (low, middle, high) based on quartiles. Associations with sodium prescription, pre-dialysis sodium, hemoglobin, and overhydration (BCM®) were assessed. Results 65,614 HD/HDF treatments (43% HDF, 57% HD) of 511 patients (69% male, mean age 66.9 years) were analyzed, averaging 128 treatments per patient. Mean sodium prescription was 137.30 mmol/l. Mean total (diffusive + ultrafiltration) sodium removal was 15.25 g (350.6 mmol), however, considering only the diffusive balance, we administered an average of 2.28 g (52.39 mmol) of sodium per session (standard deviation: 3.90), with no observed differences between clinics. Only 38% of the sessions had a neutral [−1 to 1 g] (20%) or negative (18%) sodium diffusive balance (Fig. 1). In patients with diabetes, the mean sodium diffusive balance was +2.77 g compared to +1.90 g in those without, with overlapping box plots. In patients with hypertension at baseline, mean balance was +2.17 g vs. +2.52 g in non-hypertensive patients, again with overlapping box plots. No differences in sodium balances were observed for patients with cardiovascular disease (+2.45 g vs. +2.16 g). Analyzing the dialysis modalities HD and HDF revealed no clinically relevant differences in sodium diffusive balances (HD mean +2.40 g, HDF +2.12 g). Classification of sodium balance into low, middle, and high confirmed these results. Laboratory values across these groups showed no differences (Table 1). Conclusion Real-world data analyses conducted on treatment level showed that despite average sodium prescriptions being below what is reported in the literature1, the diffusive balances were positive in most patients. Although sodium prescription is the value typically analyzed in studies, it is not the only determinant of diffusive sodium balance. In our data, we did not find a significant relationship between sodium balance and sodium prescription, patient baseline comorbidities or treatment modality. Understanding sodium balances provides insights into optimizing dialysis prescriptions for individual patients. Future analyses will incorporate advanced modeling to evaluate nested data and account for confounding factors.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.