Evaluating Hyponatremia in Non-Diabetic Uremic Patients on Peritoneal Dialysis

Ming-Tso Yan; Chih-Jen Cheng; Hsiu-Yuan Wang; Chwei-Shiun Yang; Sheng-Jeng Peng; Shih-Hua Lin

doi:10.3747/pdi.2014.00239

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Evaluating Hyponatremia in Non-Diabetic Uremic Patients on Peritoneal Dialysis

Journal article

Open access

Peer reviewed

Evaluating Hyponatremia in Non-Diabetic Uremic Patients on Peritoneal Dialysis

Ming-Tso Yan, Chih-Jen Cheng, Hsiu-Yuan Wang, Chwei-Shiun Yang, Sheng-Jeng Peng and Shih-Hua Lin

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, Vol.36(2), pp.196-204

03/01/2016

DOI: 10.3747/pdi.2014.00239

PMCID: PMC4803366

PMID: 26374835

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Abstract

♦ An approach to hyponatremia in uremic patients on peritoneal dialysis (PD) necessitates the assessment of intracellular fluid volume (ICV) and extracellular volume (ECV). The aim of the study was to evaluate the association of plasma sodium (Na(+)) concentration and body fluid composition and identify the causes of hyponatremia in non-diabetic PD patients. ♦ Sixty non-diabetic uremic patients on PD were enrolled. Baseline body fluid composition, biochemistry, hand-grip test, peritoneal membrane characteristics, dialysis adequacy, Na(+) and water balance, and residual renal function (RRF) were measured. These parameters were reevaluated for those who developed hyponatremia, defined as serum Na(+) concentration < 132 mmol/L and a decline in serum Na(+) > 7 mmol/L, during monthly visits for 1 year. Body fluid composition was determined by multi-frequency bioelectrical impedance (BIA). ♦ There was no significant correlation between serum Na(+) concentrations and any other parameters except a negative correction with overnight ultrafiltration (UF) amount (p = 0.02). The ICV/ECV ratio was positively correlated with serum albumin (p < 0.005) and hand grip strength (p < 0.05). Over 1 year, 9 patients (M:F = 3:6, aged 35 - 77) with 4 different etiologies of hyponatremia were identified. Hyponatremic patients with a body weight (BW) loss had either an increased ICV/ECV ratio associated with primarily a negative Na(+) balance (n = 2) or a reduced ratio of ICV/ECV associated with malnutrition (n = 2). In contrast, hyponatremic patients with a BW gain had either a reduced ICV/ECV ratio associated with a rapid loss of RRF and a higher peritoneal permeability (n = 2) or a normal to increased ICV/ECV ratio associated with high water intake (n = 3). ♦ Besides BW change and ultrafiltration rate, the assessment of ICV/ECV ratio is valuable in identifying the etiologies of hyponatremia in PD and provides a guide for optimal therapy.

Adult

Body Composition

Body Fluids

Cross-Sectional Studies

Electric Impedance

Female

Humans

Hyponatremia - physiopathology

Kidney Failure, Chronic - physiopathology

Kidney Failure, Chronic - therapy

Male

Middle Aged

Nutritional Status

Peritoneal Dialysis

Peritoneum - metabolism

Prospective Studies

Sodium - blood

Ultrafiltration

Uremia - physiopathology

Water-Electrolyte Balance

Details

Title: Subtitle: Evaluating Hyponatremia in Non-Diabetic Uremic Patients on Peritoneal Dialysis
Creators: Ming-Tso Yan - Cathay General Hospital
Chih-Jen Cheng - Tri-Service General Hospital
Hsiu-Yuan Wang - National Defense Medical Center
Chwei-Shiun Yang - Fu Jen Catholic University
Sheng-Jeng Peng - Fu Jen Catholic University
Shih-Hua Lin - National Defense Medical Center
Resource Type: Journal article
Publication Details: Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, Vol.36(2), pp.196-204
DOI: 10.3747/pdi.2014.00239
PMID: 26374835
PMCID: PMC4803366
ISSN: 0896-8608
eISSN: 1718-4304
Language: English
Date published: 03/01/2016
Academic Unit: Nephrology; Internal Medicine
Record Identifier: 9984383311802771

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