Hyponatremia in peritoneal dialysis : free water overload, hyperosmolarity or malnutrition ?
Hyponatremia is one of the most common electrolyte abnormalities in clinical practice and is associated with higher morbidity and mortality. On dialysis, hyponatremia is also quite common: 6 to 29% of hemodialysis patients and 11 to 26% of peritoneal dialysis (PD) patients have a serum ≤ 135mmol / L.
Hyponatremia in PD has unique aspects that confer different clinical consequences and treatment needs compared to subjects with normal kidney function.
The specificities of PD are mainly related to an ultrafiltrate quality, both in terms of sodium extraction and free water transfer, different according to the osmotic agent used in the dialysate (crystalloid or colloid osmotic agent) and according to the characteristics of the peritoneal membrane (functionality of aquaporins, preservation of osmotic conductance to glucose ...).
In the short or medium term, loss of residual renal function is highly correlated with the appearance of hyponatremia.
Finally, undernutrition, a frequent situation in dialysis and often associated with hypokalemia, can also be a cause of hyponatremia.
The purpose of this article is to help understand the pathophysiology of hyponatremia in PD, which is of paramount importance to ensure appropriate treatment.
Cherney, DZ et al. A physiological analysis of hyponatremia: implications for patients on peritoneal dialysis. Perit Dial Int 2001 Jan;21 (1):7-13
M. Rhee,CM, et al. Hyponatremia in the Dialysis Population. Kidney Int Rep 2019;4,769–780 https://doi.org/10.1016/j.ekir.2019.02.012
Rippe B,Venturoli et al. Fluid and electrolyte transport across the peritoneal membrane during CAPD according to the three-pore model. Perit Dial Int 2004 Jan-Feb 24 (1)):10-27
Zanger, R. Hyponatremia and Hypokalemia in Patients on Peritoneal Dialysis. Seminars in Dialysis 2010 Nov-Dec;23 (6): 575–580. https://doi.org/10.1111/j.1525-139X.2010.00789
Minhtri K. Nguyen and Ira Kurtz. Determinants of plasma water sodium concentration as reflected in the Edelman equation: role of osmotic and Gibbs-Donnan equilibrium. Am J Physiol Renal Physiol 2004; 286:F828–F837.
Dimitriadis et al : Hyponatremia in Peritoneal Dialysis: Epidemiology in a Single Center and Correlation with Clinical and Biochemical Parameters. Perit Dial Int 2014 May;34 (3) : 260-270. doi: 10.3747/pdi.2012.00095
Kim, S.: 2011 Progress in Peritoneal Dialysis: editeur R Krediet. doi: 10.5772/891. Available at : http://www.intechopen.com/books/progress-in-peritoneal-dialysis
Spasovski,S, Vanholder,R . Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014 Feb 25;170(3):G1-47. doi: 10.1530/EJE-13-1020
Musso , C.· Bargman, J.: Asymptomatic hyponatremia in peritoneal dialysis patients: an algorithmic approach: letter to editor . International Urology and Nephrology November 2014; 46 (11) : 2239–2241
Vrtovsnik, F. Nouveaux dialysats péritoneaux pour quel bénéfice? Bulletin de la Dialyse à Domicile. 2018; 1 (3): available at https://doi.org/10.25796/bdd.v1i3.63
Turchin, A et al. Mind the gap. N Engl J Med 2003; 349:1465-1469. doi 10.1056/NEJMcps031078
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