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Abstract: PO1148

Automated Early Detection of Hyponatremia in Hemodialysis Patients Derived from Online Conductivity Measurement

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Maierhofer, Andreas, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
  • Harlos, Joachim, MVZ Dialysezentrum Schweinfurt, Schweinfurt, Bayern, Germany
  • Canaud, Bernard J., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
Background

Hyponatremia in dialysis patients is a strong indicator of poor outcome 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 earlier alert the physician of underying clinical illnesses.

Methods

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 11 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. In addition, in each case the onset of hyponatremia was linked to a subacute illness development (i.e., sepsis, congestive heart failure, …) underpinned by various degrees of fluid overload. Correction of the underlying pathology and fluid overload by dry weight adjustement permitted to improve clinical outcome.

Conclusion

The clinical examples show that due to the good agreement of the time course of pPlNa and Na-Lab, pPlNa can be used as adjuvant diagnostic tool for the early detection of onset and progression of morbid events.
This online tool will support physicians in decision making for improving dialysis patient management and likely outcome.
Further studies are deserved to confirm the clinical value of this tool.

Example for the agreement between the time course of pPlNa and Na-Lab, and to clinically manifested illness during a period of hyponatremia

Funding

  • Commercial Support