Abstract: FR-PO816

Measured versus Prescribed Dialysate Sodium Using Dialysis Machines from Different Manufacturers

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Gul, Ambreen, DCI, Albuquerque, New Mexico, United States
  • Miskulin, Dana, Tufts Medical Center, Sommerville, Massachusetts, United States
  • Harford, Antonia, UNM, Albuquerque, New Mexico, United States
  • Schrader, R., DCI, Albuquerque, New Mexico, United States
  • Paine, S., DCI, Albuquerque, New Mexico, United States
  • Bender, Walter L, Dialysis Clinic Inc., Kansas City, Missouri, United States
  • Thajudeen, Bijin, University of Arizona, Tucson, Arizona, United States
  • Zager, Philip, UNM, Albuquerque, New Mexico, United States
Background

The optimal dialysate sodium (DNa) is unknown. We previously reported that differences (measured - prescribed DNa) in facilities using Fresenius and Gambro machines ranged from +13 mEq/L to - 6 mEq/L (mean + 2.5 mEq/L), which may contribute to the disparate results of published studies. We extended these observations by assessing differences in facilities using B. Braun machines.

Methods

We studied 2 DCI facilities that use B.Braun Dialog+ machines with either NaturaLyte or Diasol dialysate. Technicians entered DNa orders into the machine, which were verified by a nurse. We turned on dialysate machines ≥ 30 minutes prior to sampling. We clamped the saline line and sampled dialysate from the dialysate port 10 minutes prior to the start of dialysis in clinics 5 (24 machines, 97 treatments) and 6 (25 machines, 54 treatments). We sampled dialysate 10 minutes prior to end of dialysis in clinics 5 (n=91) and 6 (n=54). The DCI lab measured DNa concentrations with an indirect ion selective electrode. We assessed the differences (measured- prescribed DNa) by computing least square means with a linear mixed model that accounted for random machine effects and repeated measures.

Results

Measured DNa was 3.36 mEq/L (95% CI 2.69 – 4.02) and 1.82 mEq/L (95% CI 1.08 – 2.56) higher than prescribed in Units 5 and 6, respectively. The percentages of DNa measurements within 2 mEq/L of that ordered were 22.2% and 59.5% in Unit 5 & 6, respectively. DNa in late in dialysis was also higher than prescribed in clinics 5 (4.14 mEq/L [ 95% CI 3.54 – 4.73]) and 6 (1.81 mEq/L, [95% CI 1.15 – 2.47]). Measured DNa in samples drawn pre- and late- dialysis were similar. In clinic 5 26 pairs (28.6%) matched and 67 (73.6%) were within 1mEq/L. Corresponding numbers in clinic 6 were 22 (40.7%) and 47 (87%). The weighted kappa was 0.63 indicating good agreement between pre- and late dialysis DNa.

Conclusion

Measured DNa is higher than prescribed with Fresenius, Gambro, and B.Braun machines. QAPI programs should incorporate measurements of DNa to ensure adherence to the dialysis prescription.