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Abstract: FR-PO476

Variability Between Prescribed and Measured Dialysate Sodium in the Acute Care Hemodialysis: Effects of Additives and Other Electrolytes

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wiegley, Nasim, University of California, Davis, Sacramento, California, United States
  • Paracuelles, Vincent, University of California, Davis, Sacramento, California, United States
  • Craig, Maureen, University of California, Davis, Sacramento, California, United States
  • Don, Burl R., University of California, Davis, Sacramento, California, United States
  • Chin, Andrew I., University of California, Davis, Sacramento, California, United States
Background

Significant variance in ordered versus measured dialysate Na has been noted in the outpatient HD setting. We examined this variance in a large hospital acute care hemodialysis program.

Methods

Dialysate electrolyte panels (DEP) were examined with point of care concentrates in an inpatient HD unit (Fresenius machines). DEP labs included Na, K, HCO3, PO4, and Mg. Ordered versus measured values for each electrolyte were analyzed by linear mixed model that included the particular HD machine for random effect. Logistic regression modeling was used to determine factors associated with significant variance between ordered and measured values.

Results

5416 HD treatments identified. Significant differences noted between ordered and measured Na, HCO3 and Mg, but not K (Table 1). We focused on Na; 94% of HD’s had differences of ± 5 mEq/L between ordered and measured dialysate Na levels. Bland-Altman plot showed skew towards a lower delivered versus ordered dialysate Na concentration. In 694 HD treatments, dialysate Na was manually corrected based on the first out of range measured Na. On repeat, 86.3% of treatments were within ± 3 mEq/L of the ordered Na. On logistic regression modeling for factors associated with measured dialysate Na >5 mEq/L out of range, phosphorus added to the dialysate and ordered dialysate Na > or < 140 were both statistically significant; 2.63 (1.38 - 5.02) and 1.10 (1.04 - 1.15), respectively.

Conclusion

There were significant differences between prescribed and measured dialysate Na, HCO3 and Mg, but not with K. Measured Na was on average 1.75 mEq/L lower than ordered; a difference of >5 mEq/L was found in 6% of HDs. Manual adjustment of dialysate Na setting, when performed, corrected this difference 86% of instances when rechecked on the same HD. Additives to the dialysate solution and ordered dialysate Na > or < 140 were associated with out of range measured Na

Funding

  • Clinical Revenue Support