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Relationship between sodium removal, hydration and outcomes in peritoneal dialysis patients.

BACKGROUND
Fluid overload (FO) in peritoneal dialysis (PD) patients is associated with mortality. We explore if low daily sodium removal is an independent risk factor for mortality. We examined severely FO PD patients established for >1yr in expectation that PD prescription would have been optimised for solute clearance and ultrafiltration. We also wish to determine the relationship between kt/v and sodium removal.


METHODS
Retrospective analysis of 231 PD patients with FO ≥2.0L and compared with 218 PD patients who were euvolaemic throughout their PD treatment. Patients were followed up until death censored for transplantation.


RESULTS
Mean daily sodium removal in overhydrated patients was only 75mmoles (=1.7g). CAPD usage was more common in patients with highest sodium removal. Achievement of UK guidelines for solute clearance and daily fluid removal were not independent predictors of mortality. Markers of sarcopenia (low serum albumin and high CRP) were associated with increased mortality, but these parameters were not independent predictors in a model that included functional assessment (Karnofsky Score). Daily sodium removal was not predictive of mortality but imprecision of clinically used sodium assay should be noted. Correlation between Na and kt/v is statistically significant but R2 was weak at 0.07.


CONCLUSIONS
Whilst diabetic males were more likely to become overhydrated, these factors did not increase mortality further. Traditional targets of "dialysis adequacy" did not predict survival. Kt/v is not a good indicator of sodium removal which can be surprisingly low. Measuring sodium clearance may help clinicians optimise PD modality (CAPD vs APD). This article is protected by copyright. All rights reserved.