Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

作者：Hecking Manfred; Karaboyas Angelo; Saran Rajiv; Sen Ananda; Inaba Masaaki; Rayner Hugh; Hoerl Walter H; Pisoni Ronald L; Robinson Bruce M; Sunder Plassmann Gere; Port Friedrich K^*

来源：Clinical Journal of the American Society of Nephrology, 2012, 7(1): 92-100.

DOI：10.2215/CJN.05440611

Background and objectives Recommendations to decrease the dialysate sodium (DNa) prescription demand analyses of patient outcomes. We analyzed morbidity and mortality at various levels of DNa, simultaneously accounting for interdialytic weight gain (IDWG) and for the mortality risk associated with lower predialysis serum sodium (SNa) levels. %26lt;br%26gt;Design, setting, participants, %26 measurements We used multiply-adjusted linear mixed models to evaluate the magnitude of IDWG and Cox proportional hazards models to assess hospitalizations and deaths in 29,593 patients from the Dialysis Outcomes and Practice Patterns Study with baseline DNa and SNa as predictors, categorized according to lowest to highest levels. %26lt;br%26gt;Results IDWG increased with higher DNa across all SNa categories, by 0.17% of body weight per 2 mEq/L higher DNa; however, higher DNa was not associated with higher mortality in a fully adjusted model (also adjusted for SNa; hazard ratio [HR]=0.98 per 2 mEq/L higher DNa, 95% confidence interval [CI] 0.95-1.02). Instead, higher DNa was associated with lower hospitalization risk (HR=0.97 per 2 mEq/L higher DNa, 95% CI 0.95-1.00, P=0.04). Additional adjustments for IDWG did not change these results. hi sensitivity analyses restricted to study facilities, in which 90%-100% of patients have the same DNa (56%), the adjusted HR for mortality was 0.88 per 2 mEq/L higher DNa (95% CI 0.83-0.94). These analyses represented a pseudo-randomized experiment in which the association between DNa and mortality is unlikely to have been confounded by indication. %26lt;br%26gt;Conclusions In the absence of randomized prospective studies, the benefit of reducing IDWG by decreasing DNa prescriptions should be carefully weighed against an increased risk for adverse outcomes. Clin J Am Soc Nephrol 7: 92-100, 2012. doi: 10.2215/CJN.05440611

• 出版日期2012-1