Seasonal variations in serum sodium levels and other biochemical parameters among peritoneal dialysis patients

Li, Szu‐Yuan; Chen, Jinn-Yang; Chuang, Chiao‐Lin; Chen, Tzen‐Wen

doi:10.1093/ndt/gfm618

Cited by 23 publications

(19 citation statements)

References 23 publications

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“…We noted limited variability of serum sodium levels throughout the year, which is in contrast to recent observations in 44 Chinese peritoneal dialysis patients (5%) [6] , but in agreement with previous data evaluating seasonal variability of biochemical parameters in 1,172 HD patients in the US (0.6%, which was statistically significant but of minimal clinical relevance) [7] , possibly implicating dialysis modality and/or differences in climate as re- sponsible factors. On the other hand, predialysis sodium levels may be occasionally 'off', as indicated by the average range of 7.1 m M (as high as 16 m M in one of our subjects), demonstrating that a single measurement may not reflect the average pre-HD serum sodium.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Stability of Serum Sodium in Hemodialysis Patients

et al. 2010

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Background: A direct relationship between dialysate-to-plasma sodium gradient, blood pressure and interdialytic weight gain exists in hemodialysis (HD) patients. The aim of this study was to delineate the long-term variability of serum sodium in HD patients. Methods: We performed a retrospective cohort analysis of serum sodium and other analytes routinely evaluated in 100 stable chronic HD patients observed for 12 months. Results: Individual levels across the cohort varied from 122 to 145 mM, but 12-month intraindividual coefficients of variation for sodium were low (pre-HD = 1.6%; post-HD = 1.8%) with overall variability similar to that related to laboratory assay variability especially when compared with other analytes (3.1–30.8%). Pre-HD serum sodium had a trend toward hyponatremia (mean 136 ± 0.8 mM). Conclusion: Serum sodium is stable over time in HD patients. Pre-HD serum sodium may be used as a parameter for individualizing dialysate sodium prescription.

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Section: Discussionsupporting

confidence: 91%

Long-Term Stability of Serum Sodium in Hemodialysis Patients

et al. 2010

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“…The same phenomenon was also documented in PD: daily ultrafiltration volume difference of 200 mL (9). The mechanism of this variation has not been well explained; however, our previous study speculated it is related to perspiration and different patterns of PD dialysate utilization for cold and warm seasons (9).…”

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confidence: 53%

“…Peritoneal dialysis is another widely used modality of renal replacement therapy; due to its continuous nature, less abrupt changes in serum composition are presumed by most nephrologists. However, our previous study of 44 patients demonstrated that PD patients also have higher ultrafiltration volume in winter by means of more hypertonic PD solution utilization (9). The limited study subject number does not allow application of the result to all PD patients.…”

Section: Discussionmentioning

confidence: 96%

The Effect of Weather on Peritoneal Dialysis (PD) Prescription: Seasonal Variation in PD Dialysate Utilization

Chen

et al. 2010

Perit Dial Int

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“…This is particularly of interest for this cat- ion, given the well-established seasonal variation of SNa and also the ultrafiltration volume in dialysis patient, which was shown in the paper by Li et al [11]. Given the 1-year observation period, the DR of SNa may to some extent also be subject to the influence of seasonal variation of temperature, fluid overload, interdialytic weight gain [11,[38][39][40].…”

Section: Discussionmentioning

confidence: 91%

“…However, next to an overall stability, Peixoto et al [10] also showed a variation of SNa with a yearly mean SD of SNa levels of approximately 2.0 mEq/L and a mean range of 7 mEq/L for an individual dialysis patient. Further, a seasonal variation of pre-HD SNa was shown for patients with chronic kidney disease with a range of 6.96 mEq/L from summer to winter [11].…”

Section: Introductionmentioning

confidence: 94%

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

Kooman

Sande

et al. 2018

Am J Nephrol

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Background: Low serum sodium (SNa) is associated with an increased mortality in chronic hemodialysis (HD) patients. Dialysis patients are thought to have an individual pre-dialysis SNa set-point, yet there is evidence for variability of pre-dialysis SNa in individual patient. In this study, we explored the association of several SNa variability metrics with all-cause mortality in a large patient population from the international MONitoring Dialysis Outcomes (MONDO) Initiative. Methods: All adult incident patients from the MONDO database with more than 5 SNa measurements during the first year on HD were included. All patients were required to survive the first year on HD (defined as the baseline). During the subsequent 2 years of follow-up, all-cause mortality was recorded. The following variability indicators were calculated during baseline: mean SNa and its SD; average real variability (ARV, average the absolute distance of the 2 consecutive SNa measurements), and average directional range (DR, the difference between minimum and maximum values). We used Cox Proportional hazard model with bivariate spline terms to analyze the joint association of SNa and SD, ARV and DR, respectively, with all-cause mortality. While conducting the multivariate Cox regression analyses, patients were stratified into 3 groups of DR (Negative DR: –20≤ DR ≤ –6, Null DR: –6< DR < 6 and Positive DR: 6≤ DR ≤20) with the Null DR as the reference group. Results: We included 20,216 patients in the study. A SNa ≤135 mEq/L was observed to be the strongest predictor of evaluated mortality risk. Higher SNa variability (quantified as SD, ARV, and DR) was also associated with an increased mortality irrespective of SNa levels. When compared with higher SD or ARV, greater DR showed a stronger association with an elevated risk of death. Controlling the Cox Proportional hazard models for additional parameters showed consistent results. Conclusion: Higher SNa variability associated with increased all-cause mortality at all levels of SNa. DR of SNa showed the strongest association with mortality and may constitute a Simple and novel prognostic indicator, easily applicable at the bedside.

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Seasonal variations in serum sodium levels and other biochemical parameters among peritoneal dialysis patients

Cited by 23 publications

References 23 publications

Long-Term Stability of Serum Sodium in Hemodialysis Patients

Long-Term Stability of Serum Sodium in Hemodialysis Patients

The Effect of Weather on Peritoneal Dialysis (PD) Prescription: Seasonal Variation in PD Dialysate Utilization

Increased Mortality Associated with Higher Pre-Dialysis Serum Sodium Variability: Results of the International MONitoring Dialysis Outcome Initiative

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