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29.03.2023 | Original Article

Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study

verfasst von: Fabio Paglialonga, Rukshana Shroff, Ilona Zagozdzon, Sevcan A. Bakkaloglu, Ariane Zaloszyc, Augustina Jankauskiene, Alejandro Cruz Gual, Silvia Consolo, Maria Rosa Grassi, Louise McAlister, Aleksandra Skibiak, Burcu Yazicioglu, Giuseppe Puccio, Alberto Edefonti, Gema Ariceta, Christoph Aufricht, Tuula Holtta, Guenter Klaus, Bruno Ranchin, Claus Peter Schmitt, Evelien Snauwaert, Costantinos Stefanidis, Johan Vande Walle, Stella Stabouli, Enrico Verrina, Enrico Vidal, Karel Vondrak, Alexandra Zurowska, on behalf of the European Pediatric Dialysis Working Group (EPDWG)

Erschienen in: Pediatric Nephrology | Ausgabe 10/2023

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Abstract

Background

Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis.

Methods

Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa). Primary outcomes were systolic blood pressure and diastolic blood pressure standard deviation scores (SBP and DBP SDS), obtained by 24-h ambulatory blood pressure monitoring or office BP according to age, and interdialytic weight gain (IDWG).

Results

Forty-one patients (31 HD), with a median age of 13.3 (IQR 5.2) years, were enrolled. Twelve patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.7) mEq/kg/day. Median total Na intake was 1.5 (1.1) mEq/kg/day, corresponding to 60.6% of the maximum recommended daily intake for healthy children. Median uNa and sNaB were 0.6 (1.8) mEq/kg/day and 0.9 (1.7) mEq/kg/day, respectively. The strongest independent predictor of sNaB in the cohort was urine output. In patients receiving HD, sNaB correlated with IDWG, pre-HD DBP, and first-hour refill index, a volume index based on blood volume monitoring. sNaB was the strongest predictor of IDWG in multiple regression analysis (β = 0.63; p = 0.005). Neither SBP SDS nor DBP SDS correlated with sNaB.

Conclusions

Na intake is higher than uNa in children on dialysis, and medications may be an important source of Na. sNaB is best predicted by urine output in the population, and it is a significant independent predictor of IDWG in children on HD.

Graphical abstract

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Titel: Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study
verfasst von: Fabio Paglialonga
Rukshana Shroff
Ilona Zagozdzon
Sevcan A. Bakkaloglu
Ariane Zaloszyc
Augustina Jankauskiene
Alejandro Cruz Gual
Silvia Consolo
Maria Rosa Grassi
Louise McAlister
Aleksandra Skibiak
Burcu Yazicioglu
Giuseppe Puccio
Alberto Edefonti
Gema Ariceta
Christoph Aufricht
Tuula Holtta
Guenter Klaus
Bruno Ranchin
Claus Peter Schmitt
Evelien Snauwaert
Costantinos Stefanidis
Johan Vande Walle
Stella Stabouli
Enrico Verrina
Enrico Vidal
Karel Vondrak
Alexandra Zurowska
on behalf of the European Pediatric Dialysis Working Group (EPDWG)
Publikationsdatum: 29.03.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 10/2023
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-05932-y

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Sodium intake and urinary losses in children on dialysis: a European multicenter prospective study