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Troché G, Laurent V, Ferré A, Jacq G, Paul M, Merceron S, Legriel S. Natraemia variations induced by acute dialysis in critically ill patients: a database study. Sci Rep 2022; 12:14930. [PMID: 36056117 PMCID: PMC9440038 DOI: 10.1038/s41598-022-18897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
Natraemia is often abnormal in critically ill patients and may change rapidly during renal replacement therapy (RRT). This database study in a single intensive care unit (ICU) evaluated natraemia before and after the first RRT session for acute kidney injury. Of 252 patients who required RRT in 2018-2020, 215 were included. Prevalences were 53.9% for hyponatraemia (≤ 135 mmol/L) and 3.7% for hypernatraemia (> 145 mmol/L). Dialysate sodium was ≥ 145 mmol/L in 83% of patients. Median dialysis sodium gradient was 12 mmol/L, with a value above 16 mmol/L in 25% of patients. Median natraemia increased from 135 before to 140 mmol/L after RRT, the median hourly increase being faster than recommended, at 1.0 mmol/L [0.2-1.7]. By multivariate analysis, the only variable significantly associated with the RRT-induced natraemia change was the dialysis sodium gradient [odds ratio, 1.66; 95% confidence interval 1.39-2.10]. Pearson's correlation coefficient between the gradient and the natraemia change was 0.57. When performing RRT in ICU patients, in addition to the haemodynamic considerations put forward in recommendations, the dialysis sodium gradient deserves careful attention in order to control natraemia variations. Studies to devise a formula for predicting natraemia variations might prove helpful to confirm our results.
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Affiliation(s)
- Gilles Troché
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France.
| | - Virginie Laurent
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Alexis Ferré
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Gwenaelle Jacq
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Marine Paul
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Sybille Merceron
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Stephane Legriel
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
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