Abstract: FR-PO425
Impact of Lowering Dialysate Sodium Concentration on Interdialytic Weight Gain in a Pediatric Hemodialysis Center: A Quality Improvement Study
Session Information
- Pediatric Nephrology - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Al Barbandi, Malek, Jackson Memorial Hospital, Miami, Florida, United States
- Sigurjonsdottir, Vaka Kristin, Jackson Memorial Hospital, Miami, Florida, United States
- Abitbol, Carolyn L., Jackson Memorial Hospital, Miami, Florida, United States
- Katsoufis, Chryso P., Jackson Memorial Hospital, Miami, Florida, United States
- Seeherunvong, Wacharee, Jackson Memorial Hospital, Miami, Florida, United States
- Chandar, Jayanthi, Jackson Memorial Hospital, Miami, Florida, United States
- Defreitas, Marissa J., Jackson Memorial Hospital, Miami, Florida, United States
Background
Chronic fluid overload in hemodialysis (HD) patients is associated with increased morbidity and mortality due to cardiovascular disease (CVD). We evaluated the safety and impact of decreasing dialysate sodium concentration on interdialytic weight gain (IDWG) in HD patients in a pediatric center.
Methods
This was a quality improvement study in which the aim was to decrease the average monthly IDWG in 50% of patients. We included 11 participants in a single HD pediatric center. The participants underwent two 8-week treatment phases. During phase 1 the dialysate sodium concentration was 140 mEq/L, during phase 2, the concentration was lowered to 137 mEq/L. The primary outcome was the average monthly IDWG, 2-months before and after the intervention.
Results
We included 11 patients, median age 19.7 years, 54.5% were male. Two did not tolerate the change due to hypotension during sessions and were excluded from the analysis and switched back to a sodium concentration of 140 mEq/L. The mean IDWG was 4.94 ± 1.04% compared to 4.27 ± 1.57% during phase 1 and phase 2, respectively. The IDWG decreased significantly by 0.67% in phase 2 compared with phase 1 (p = 0.04) (Figure, left). In addition, 89% of the patients had a decline in their average IDWG after the decrease in dialysate sodium, which was above our target of 50% (Figure, right).
Conclusion
While low sodium dialysate concentration in pediatric patients undergoing HD resulted in a clinical and statistically significant decrease in IDWG, it was not tolerated in some participants. Lower sodium gradient should be considered in children and young adults who are not prone to hypotension to decrease the thirst drive, limit excessive IDWG, and subsequent risk of CVD.