The impact of ultrafiltration, diuretic therapy, heart failure and diabetes mellitus on sodium homeostasis in patients with ESRD: A cross-sectional analysis

• Main Authors: Madhura AR, Jayaraj PM
• Format: Article
• Language: English
• Published: KIMS Foundation and Research Center 2020-10-01
• Series: Journal of Medical and Scientific Research
• Subjects: inter-dialytic weight gain; ultrafiltration; esrd; heart failure; diabetes; sodium homeostasis
• Online Access: http://jmsronline.com/article.aspx?ID=Ultrafiltration-diuretic-therapy-heart-failure-diabetes-mellitus-on-sodium-homeostasis

Background: Sodium homeostasis is significantly altered in patients with End Stage Renal Disease (ESRD). Higher inter-dialytic weight gain, larger volume of ultrafiltration during hemodialysis, presence of heart failure and associated diabetes mellitus increase the risk of hyponatremia in these patients. Severity of hyponatremia can predict morbidity and mortality in ESRD. Objectives: To study the impact of average weight gain, average ultrafiltrate removed per dialysis, associated heart failure and diabetes mellitus on serum sodium levels in ESRD patients. Methods: We studied 60 patients of ESRD undergoing hemodialysis. History of co-morbidities, duration of hemodialysis, diuretic usage, dialysis records were obtained and their impact on serum sodium levels were analysed statistically. Results: Among 60 participants, 18% had mild, 38% had moderate and 44% had severe hyponatremia. The average inter-dialytic weight gain was 1.86±0.55 L in mild, 2.19±0.56 L in moderate and 2.80±0.44 L in severe hyponatremia groups (p=0.0001). The average ultrafiltration per hemodialysis was 1.69±0.56 L in mild, 2.02±0.53 L in moderate and 2.62±0.36 L in severe hyponatremia groups (p=0.0001). 53% patients were on furosemide out of whom 72% had severe hyponatremia (p=0.0001). 58% patients had chronic heart failure (CHF) out of whom 74% had severe hyponatremia (p=0.0001). 70% patients had diabetes mellitus (DM) out of whom 62% had severe hyponatremia (p=0.0001). Conclusion: There was a significant negative correlation between average weight gain/average ultrafiltration per dialysis and serum sodium levels. The study strongly established the impact of heart failure and diabetes mellitus on serum sodium levels in ESRD.