P1067CONDUCTIVITY BASED ONLINE MONITORING OF PREDIALYTIC HYPONATREAMIA AS DIAGNOSTIC TOOL IN HEMODIALYIS

Abstract

Abstract Background and Aims Hyponatremia in dialysis patients is a strong indicator of poor outcome in dialysis patients that requires early detection to facilitate clinical workup and management. However, plasma sodium concentration as determined by lab methods (Na-Lab) is measured at the best monthly in clinical practice. Recently, online monitoring of predialytic plasma Na (pPlNa) as estimated from dialysate conductivity using an electrolyte model has become available at every hemodialysis session, thus providing an unprecedented close and almost continuous monitoring of this crucial indicator. This could be used as diagnostic tool to identify changes in patient status and alert earlier the physician. Method In a monocentric retrospective clinical study in 114 patients on maintenance hemodialysis (>90% online postdilution HDF) for whom online pPlNa was available for a period of at least 12 months at least once a week, kinetics of pPlNa were analyzed. For 10 patients with hyponatremic episodes as manifested in pPlNa, the agreement between time course of pPlNa and Na-Lab and the correlation to the manifestation of clinical findings was explored. Results Time course of pPlNa and Na-Lab showed very good agreement. Hyponatremia onset was clinically related to diagnoses such as fluid overload and congestive heart failure, diarrhea secondary to inflammatory bowel disease, sepsis, liver cirrhosis, cancer and use of loop diuretics. Conclusion The clinical examples show that due to the good agreement of the time course of online monitoring of pPlNa and Na-Lab, pPlNa can be used as adjuvant diagnostic tool for the early detection of onset and progression of morbid events. Due to its routine availability variations in pPlNa could be used to timely trigger clinical workup and investigations.