Abstract
Background: Sodium homeostasis is significantly altered in patients with End Stage Renal Disease (ESRD). Higher inter-dialytic weight gain, larger volume of ultrafiltration during hemodialysis, presence of heart failure and associated diabetes mellitus increase the risk of hyponatremia in these patients. Severity of hyponatremia can predict morbidity and mortality in ESRD. Objectives: To study the impact of average weight gain, average ultrafiltrate removed per dialysis, associated heart failure and diabetes mellitus on serum sodium levels in ESRD patients. Methods: We studied 60 patients of ESRD undergoing hemodialysis. History of co-morbidities, duration of hemodialysis, diuretic usage, dialysis records were obtained and their impact on serum sodium levels were analysed statistically. Results: Among 60 participants, 18% had mild, 38% had moderate and 44% had severe hyponatremia. The average inter-dialytic weight gain was 1.86±0.55 L in mild, 2.19±0.56 L in moderate and 2.80±0.44 L in severe hyponatremia groups (p=0.0001). The average ultrafiltration per hemodialysis was 1.69±0.56 L in mild, 2.02±0.53 L in moderate and 2.62±0.36 L in severe hyponatremia groups (p=0.0001). 53% patients were on furosemide out of whom 72% had severe hyponatremia (p=0.0001). 58% patients had chronic heart failure (CHF) out of whom 74% had severe hyponatremia (p=0.0001). 70% patients had diabetes mellitus (DM) out of whom 62% had severe hyponatremia (p=0.0001). Conclusion: There was a significant negative correlation between average weight gain/average ultrafiltration per dialysis and serum sodium levels. The study strongly established the impact of heart failure and diabetes mellitus on serum sodium levels in ESRD.
Highlights
Serum sodium concentration in humans is tightly regulated, with normal levels between 135 and 144 mEq/L [1]
The average ultrafiltration per hemodialysis was 1.69±0.56 L in mild, 2.02±0.53 L in moderate and 2.62±0.36 L in severe hyponatremia groups (p=0.0001). 53% patients were on furosemide out of whom 72% had severe hyponatremia (p=0.0001). 58% patients had chronic heart failure (CHF) out of whom 74% had severe hyponatremia (p=0.0001). 70% patients had diabetes mellitus (DM) out of whom 62% had severe hyponatremia (p=0.0001)
The study strongly established the impact of heart failure and diabetes mellitus on serum sodium levels in End Stage Renal Disease (ESRD)
Summary
Serum sodium concentration in humans is tightly regulated, with normal levels between 135 and 144 mEq/L [1]. In End Stage Renal Disease (ESRD), the kidneys lose the ability to concentrate urine in response to circulating AVP which can cause an imbalance between water retention and excretion and leads to hyponatremia [2]. Dilutional hyponatremia is a condition in which intravascular volume is increased and the total amount of sodium is not depleted. Inappropriate intravascular fluid retention leads to low serum sodium concentration. Ultrafiltration is a process of removing isotonic fluid without affecting effective circulating volume. Ultrafiltration can remove a higher amount of sodium in addition to isotonic fluid resulting in depletional hyponatremia. If an isotonic fluid removal rate by ultrafiltration is too fast to refill intravascular sodium from extracellular interstitial space, there can be reduction of circulating volume and sodium depletion [3]. Severity of hyponatremia can predict morbidity and mortality in ESRD
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