Study: Use of low sodium fluids for continuous renal replacement therapy safe, effective
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Use of low-sodium dialysate and replacement fluids safely prevented an “overly rapid” correction of plasma sodium in a study of patients with hyponatremia who required continuous renal replacement therapy.
“Continuous renal replacement therapy (CRRT) in patients with chronic hyponatremia is challenging since commercially available CRRT solutions have a fixed isotonic sodium concentration,” Srijan Tandukar, MD, of Willis-Knighton Medical Center in Louisiana, and colleagues, wrote. “This may increase the risk of rapid hyponatremia correction.”
According to the researchers, an infusion of a hypotonic solution or the use of a low-sodium dialysate in place of isotonic dialysate could reduce the risk, but evidence on the clinical efficacy of these methods is lacking.
Therefore, they conducted a retrospective review of 19 patients with moderate to severe hyponatremia (plasma sodium levels 126 mEq/L) who received CRRT using low-sodium dialysate and replacement fluids (119 mEq/L or 126 mEq/L) at the Presbyterian Hospital campus of the University of Pittsburgh Medical Center between January 2016 and June 2018. All patients received CRRT for at least 24 hours, with change in plasma sodium assessed at 24 and 48 hours after initiation of low-sodium CRRT and at the end of treatment (initial CRRT effluent dose was 27 mL/kg/h).
At 24 hours, the researchers found two patients (11%) had an increase in plasma sodium concentration of greater than 6 mEq/L. The mean change in plasma sodium level at 24 and 48 hours, and at the time of CRRT discontinuation, was determined to be 3 mEq/L, 3 mEq/L and 6 mEq/L, respectively, with the researchers noting that no patients developed osmotic demyelination syndrome.
“In the absence of commercially available low sodium CRRT solutions, we believe that the protocol used in our study can be safely used for patients with moderate to severe hyponatremia who require CRRT, thereby reducing risk of overcorrection of the plasma sodium,” they wrote.
Despite the observed efficacy and safety of using low-sodium CRRT, the researchers acknowledged that some pharmacies “may be reluctant to modify the standard dialysate solutions due to fear of compounding error.”
To address this concern, they suggest limiting the number of modifications, using strict protocol and monitoring patients’ chemistries shortly after initiating CRRT with low-sodium fluids.
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