Effect of Change in Sodium after Slow Low-Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2024-09-05 DOI:10.1159/000541210

Sai Saran, Namrata S Rao, Saumitra Misra, Suhail Sarwar Siddiqui, Avinash Agrawal, Ayush Lohiya, Mohan Gurjar, Prabhaker Mishra, Syed Nabeel Muzaffar

{"title":"Effect of Change in Sodium after Slow Low-Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury.","authors":"Sai Saran, Namrata S Rao, Saumitra Misra, Suhail Sarwar Siddiqui, Avinash Agrawal, Ayush Lohiya, Mohan Gurjar, Prabhaker Mishra, Syed Nabeel Muzaffar","doi":"10.1159/000541210","DOIUrl":null,"url":null,"abstract":"Introduction: The effect of sodium (Na) correction by slow low-efficiency dialysis (SLED) in dysnatremic (135 mEq/L <Na >145 mEq/L) critically ill patients is unclear.Methods: Prospective observational study enrolled dysnatremic critically ill adult patients with acute kidney injury undergoing the first SLED as cases and normonatremic patients as controls. Baseline and SLED-related parameters and 30-day mortality were noted.Results: 100 dysnatremic and 51 normonatremic patients were included, with a median age of 31 (25-52) years and median admission SOFA scores of 10 (9-12). Patients with dysnatremia at study inclusion had a mortality of 53%, with the highest mortality in severe hypernatremia (Na >160 mEq/L) (75%), followed by those with severe hyponatremia (Na <120 mEq/L) (68.6%). SLED-associated natremia change >10 mEq/L was significantly associated with mortality, in patients with mild dysnatremia and normonatremia (Na: 130-150) (p < 0.001), and not in those with moderate to severe dysnatremia (Na <130 and Na >150) (p = 0.72). Upon multivariate logistic regression analysis, a model with pre-SLED pH, dialyzate-pre-SLED Na difference, and duration of SLED significantly predicted SLED-associated natremia change (R2 0.18, p = 0.001).Conclusions: SLED can be safely and effectively performed in critically ill adults with dysnatremia requiring renal replacement therapy with mortality comparable to normonatremic controls.","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000541210","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: The effect of sodium (Na) correction by slow low-efficiency dialysis (SLED) in dysnatremic (135 mEq/L <Na >145 mEq/L) critically ill patients is unclear.

Methods: Prospective observational study enrolled dysnatremic critically ill adult patients with acute kidney injury undergoing the first SLED as cases and normonatremic patients as controls. Baseline and SLED-related parameters and 30-day mortality were noted.

Results: 100 dysnatremic and 51 normonatremic patients were included, with a median age of 31 (25-52) years and median admission SOFA scores of 10 (9-12). Patients with dysnatremia at study inclusion had a mortality of 53%, with the highest mortality in severe hypernatremia (Na >160 mEq/L) (75%), followed by those with severe hyponatremia (Na <120 mEq/L) (68.6%). SLED-associated natremia change >10 mEq/L was significantly associated with mortality, in patients with mild dysnatremia and normonatremia (Na: 130-150) (p < 0.001), and not in those with moderate to severe dysnatremia (Na <130 and Na >150) (p = 0.72). Upon multivariate logistic regression analysis, a model with pre-SLED pH, dialyzate-pre-SLED Na difference, and duration of SLED significantly predicted SLED-associated natremia change (R2 0.18, p = 0.001).

Conclusions: SLED can be safely and effectively performed in critically ill adults with dysnatremia requiring renal replacement therapy with mortality comparable to normonatremic controls.

查看原文本刊更多论文

急性肾损伤重症患者进行缓慢低效透析（SLED）后钠含量变化的影响。

简介：接受缓慢低效透析（SLED）的重症患者体内钠（Na）含量变化的影响尚不明确：接受缓慢低效透析（SLED）的重症患者体内钠（Na）含量变化的影响尚不明确：前瞻性观察研究以首次接受慢低效透析（SLED）的急性肾损伤（AKI）重症成人患者为病例，正常血钠患者为对照。研究记录了基线参数、SLED 相关参数和 30 天死亡率：共纳入 100 名血钠潴留患者和 51 名血钠正常患者，中位年龄为 31（25-52）岁，入院 SOFA 评分中位数为 10（9-12）分。纳入研究时存在血钠异常的患者死亡率为 53%，其中严重高钠血症（Na > 160 mEq/L：75%）患者死亡率最高，其次是严重低钠血症（Na < 120 mEq/L：68.6%）患者。在轻度尿毒症和正常尿毒症（Na:130-150）患者中，SLED相关的Natremia变化> 10 mEq/L与死亡率显著相关（p<0.001），而在中重度尿毒症（Na <130和Na >150）患者中，SLED相关的Natremia变化> 10 mEq/L与死亡率无关（p=0.72）。多变量逻辑回归分析显示，SLED 前 pH 值、透析液-SLED 前 Na 值差异和 SLED 持续时间模型可显著预测 SLED 相关的血钠变化（R2 0.18，p=0.001）：三分之一的重症患者在首次接受 SLED 治疗后，Na 变化可超过 10 meq/L，这与轻度血钠潴留和正常血钠潴留患者的不良预后有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.