Letter to the Editor
Peritoneal dialysis as a perpetuating cause of hyponatremia
La diálisis peritoneal como causa perpetuadora de hiponatremia
José Juan Ribés Cruz
, Jose Graña Fandos, Belen Alemany Sánchez, María Aparicio Aliaga, Yaiza Aznar Artiles, Esther Bea Reyes, Yolanda Blanco Mateos, Martina Mravcova, Diego Rodriguez Ortega, Miguel Ángel Candel Rosell
Corresponding author
Servicio de Nefrología, Hospital de la Ribera, Departamento de Salud 11, Alzira (Valencia), Spain
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She arrived for consultation due to vomiting and diarrhoea that had persisted for a week. Her regular peritoneal dialysis regimen included two 1.36% glucose exchanges (4-h dwell time), one exchange with 2.27% glucose (6-h dwell time) and a fourth exchange with icodextrin (7.5%). With a CAPD she achieved a daily negative balance of around 1900<span class="elsevierStyleHsp" style=""></span>ml. Residual diuresis was counted at around 200<span class="elsevierStyleHsp" style=""></span>ml per day. The analytical control demonstrated evidence for hyponatraemia (Na: 119<span class="elsevierStyleHsp" style=""></span>mEq/l), hypochloraemia (Cl: 78<span class="elsevierStyleHsp" style=""></span>mEq/l) and hypokalaemia (K: 3.2<span class="elsevierStyleHsp" style=""></span>mEq/l). Hydroelectrolytic reposition was begun with physiological saline supplemented with potassium chloride and the CAPD regimen was modified, eliminating the exchange with icodextrin and substituting it with a 1.36% glucose exchange. The three exchanges at 1.36% were maintained with a dwell time of 5 hours. Dwell time for the 2.27% glucose exchange was 9<span class="elsevierStyleHsp" style=""></span>h. Microbiological studies were negative. Symptomatology was self-limited to the few hours after admission, during which volume reposition was completed and potassium levels were normalised, although there was no evidence that the hyponatraemia was resolved. The sodium sieving level was 15%. During the study, it was observed that, at the end of the dwell time for a 1.36% glucose exchange, the ratio between the sodium concentration of the peritoneal dialysate effluent and that of the plasma was 100%, which meant that, based on the plasma sodium concentration at 122<span class="elsevierStyleHsp" style=""></span>mEq/l, the final sodium concentration in the dialysate effluent was 122<span class="elsevierStyleHsp" style=""></span>mEq/l. The final exchange volume was 2300<span class="elsevierStyleHsp" style=""></span>ml. The initial sodium concentration from the exchange was 134<span class="elsevierStyleHsp" style=""></span>mEq/l, which would have corresponded to a theoretical final concentration of 116.5<span class="elsevierStyleHsp" style=""></span>mEq/l. This discrepancy between the real value (122<span class="elsevierStyleHsp" style=""></span>mEq/l) and the theoretical value (116.5<span class="elsevierStyleHsp" style=""></span>mEq/l) pointed to a negative sodium balance and the exchange dwell time as the perpetuating causes of hyponatraemia. The next day, starting with a plasma sodium concentration of 120<span class="elsevierStyleHsp" style=""></span>mEq/l, the exchange dwell time was limited to 3<span class="elsevierStyleHsp" style=""></span>h and the plasma sodium increased to 124<span class="elsevierStyleHsp" style=""></span>mEq/l.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This case emphasises the importance of the influence of the peritoneum in sodium homeostasis in patients on peritoneal dialysis, going beyond the concept of sodium sieving in order to evaluate ultrafiltration failure. Free water transport through aquaporins (AQP1) induced by the osmolality of the peritoneal fluid is assessed by sodium sieving, which is considered to be reduced if a decrease of less than 5<span class="elsevierStyleHsp" style=""></span>mEq/l of sodium in the peritoneal fluid occurs (glucose concentration at 3.86%) after 60<span class="elsevierStyleHsp" style=""></span>min of infusion.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> In our patient, who maintained normal sodium sieving, the comparison between the theoretical sodium concentration in the dialysate effluent and the actual measurement at the end of the dwell time pointed towards the aetiology of persistent hyponatraemia. Although some concepts have still not been elucidated with respect to peritoneum physiology, adjusting peritoneal dialysis regimens to the serum sodium concentration may prevent the perpetuation of hydroelectrolytic imbalance. The theoretical/real sodium ratio with respect to dialysate volume upon completion of the exchange dwell time could be used to quickly evaluate the tendency of the sodium balance in peritoneal dialysis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ribés Cruz JJ, Graña Fandos J, Alemany Sánchez B, Aparicio Aliaga, A, Aznar Artiles Y, Bea Reyes, E, et al. La diálisis peritoneal como causa perpetuadora de hiponatremia. Nefrologia. 2017;37:659–660.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-infectious complications of peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Bargman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Nolph and Gokal's textbook of peritoneal dialysis" "paginaInicial" => "571" "paginaFinal" => "609" "serieFecha" => "2009" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and clinical outcomes of hyponatraemia in peritoneal dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.H. Kang" 1 => "K.H. Cho" 2 => "J.W. Park" 3 => "K.W. Yoon" 4 => "J.Y. Do" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12882-017-0541-6" "Revista" => array:6 [ "tituloSerie" => "Nephrology" "fecha" => "2013" "volumen" => "18" "paginaInicial" => "132" "paginaFinal" => "137" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28399844" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyponatremia in peritoneal dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Uribarri" 1 => "S. Prabhakar" 2 => "T. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nephrol" "fecha" => "2004" "volumen" => "61" "paginaInicial" => "54" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14964458" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyponatremia and hypokalemia in patients on peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Zanger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-139X.2010.00789.x" "Revista" => array:6 [ "tituloSerie" => "Semin Dial" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "575" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21121953" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A physiological analysis of hyponatremia: implications for patients on peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.Z. Cherney" 1 => "G. Zevallos" 2 => "D. Oreopoulos" 3 => "M.L. Halperin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Perit Dial Int" "fecha" => "2001" "volumen" => "21" "paginaInicial" => "7" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11280499" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid, electrolyte disorders in dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Port" 1 => "E. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Fluids and electrolytes" "paginaInicial" => "533" "paginaFinal" => "560" "serieFecha" => "1996" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Categorization of sodium sieving by 2.27% and 3.86% peritoneal equilibration test. A comparative analysis in the clinical setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Gómez" 1 => "M. Pérez" 2 => "A. Rodríguez" 3 => "A. Sastre" 4 => "E. Díaz" 5 => "A. López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nephrol Dial Transpl" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "3513" "paginaFinal" => "3520" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000006/v1_201712030528/S2013251417301827/v1_201712030528/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000006/v1_201712030528/S2013251417301827/v1_201712030528/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301827?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 11 | 19 |
| 2024 October | 121 | 42 | 163 |
| 2024 September | 137 | 46 | 183 |
| 2024 August | 148 | 54 | 202 |
| 2024 July | 170 | 39 | 209 |
| 2024 June | 123 | 58 | 181 |
| 2024 May | 117 | 49 | 166 |
| 2024 April | 122 | 37 | 159 |
| 2024 March | 121 | 44 | 165 |
| 2024 February | 91 | 53 | 144 |
| 2024 January | 93 | 22 | 115 |
| 2023 December | 96 | 33 | 129 |
| 2023 November | 106 | 43 | 149 |
| 2023 October | 205 | 63 | 268 |
| 2023 September | 237 | 41 | 278 |
| 2023 August | 146 | 28 | 174 |
| 2023 July | 152 | 29 | 181 |
| 2023 June | 121 | 41 | 162 |
| 2023 May | 122 | 45 | 167 |
| 2023 April | 89 | 24 | 113 |
| 2023 March | 112 | 24 | 136 |
| 2023 February | 107 | 24 | 131 |
| 2023 January | 132 | 35 | 167 |
| 2022 December | 98 | 32 | 130 |
| 2022 November | 126 | 43 | 169 |
| 2022 October | 145 | 63 | 208 |
| 2022 September | 117 | 53 | 170 |
| 2022 August | 128 | 74 | 202 |
| 2022 July | 132 | 58 | 190 |
| 2022 June | 129 | 59 | 188 |
| 2022 May | 118 | 34 | 152 |
| 2022 April | 163 | 66 | 229 |
| 2022 March | 135 | 49 | 184 |
| 2022 February | 125 | 65 | 190 |
| 2022 January | 147 | 88 | 235 |
| 2021 December | 111 | 48 | 159 |
| 2021 November | 111 | 44 | 155 |
| 2021 October | 133 | 57 | 190 |
| 2021 September | 112 | 43 | 155 |
| 2021 August | 112 | 56 | 168 |
| 2021 July | 155 | 46 | 201 |
| 2021 June | 102 | 29 | 131 |
| 2021 May | 118 | 56 | 174 |
| 2021 April | 234 | 95 | 329 |
| 2021 March | 166 | 55 | 221 |
| 2021 February | 140 | 40 | 180 |
| 2021 January | 76 | 34 | 110 |
| 2020 December | 69 | 21 | 90 |
| 2020 November | 69 | 19 | 88 |
| 2020 October | 71 | 26 | 97 |
| 2020 September | 82 | 21 | 103 |
| 2020 August | 70 | 20 | 90 |
| 2020 July | 91 | 17 | 108 |
| 2020 June | 95 | 16 | 111 |
| 2020 May | 92 | 19 | 111 |
| 2020 April | 100 | 27 | 127 |
| 2020 March | 83 | 14 | 97 |
| 2020 February | 86 | 26 | 112 |
| 2020 January | 99 | 21 | 120 |
| 2019 December | 77 | 29 | 106 |
| 2019 November | 76 | 25 | 101 |
| 2019 October | 65 | 25 | 90 |
| 2019 September | 88 | 20 | 108 |
| 2019 August | 78 | 27 | 105 |
| 2019 July | 88 | 26 | 114 |
| 2019 June | 83 | 27 | 110 |
| 2019 May | 71 | 24 | 95 |
| 2019 April | 116 | 39 | 155 |
| 2019 March | 99 | 36 | 135 |
| 2019 February | 70 | 17 | 87 |
| 2019 January | 65 | 19 | 84 |
| 2018 December | 131 | 45 | 176 |
| 2018 November | 153 | 21 | 174 |
| 2018 October | 181 | 14 | 195 |
| 2018 September | 125 | 18 | 143 |
| 2018 August | 83 | 19 | 102 |
| 2018 July | 93 | 21 | 114 |
| 2018 June | 88 | 12 | 100 |
| 2018 May | 82 | 18 | 100 |
| 2018 April | 73 | 9 | 82 |
| 2018 March | 70 | 11 | 81 |
| 2018 February | 36 | 7 | 43 |
| 2018 January | 47 | 12 | 59 |
| 2017 December | 57 | 12 | 69 |
| 2017 November | 15 | 2 | 17 |
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