Relationship between measured and prescribed dialysate sodium in haemodialysis: a systematic review and meta-analysis.

Gian Luca Di Tanna, Jule Pinter, Patrick Rossignol, Jack Kit-Chung Ng, Brendan Smyth, Mark R Marshall, Amy Kang, Abhinav Bassi, Rathika Krishnasamy, Michael V Rocco, Zuo Li, Vivekanand Jha, Carmel M Hawley, Peter G Kerr, Mark Woodward, And Meg Jardine

Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2021;36(4):695-703

PMID: 33367715

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Abstract

BACKGROUND

Dialysate sodium (DNa) prescription policy differs between haemodialysis (HD) units, and the optimal DNa remains uncertain. We sought to summarize the evidence on the agreement between prescribed and delivered DNa, and whether the relationship varied according to prescribed DNa.

METHODS

We searched MEDLINE and PubMed from inception to 26 February 2020 for studies reporting measured and prescribed DNa. We analysed results reported in aggregate with random-effects meta-analysis. We analysed results reported by individual sample, using mixed-effects Bland-Altman analysis and linear regression. Pre-specified subgroup analyses included method of sodium measurement, dialysis machine manufacturer and proportioning method.

RESULTS

Seven studies, representing 908 dialysate samples from 10 HD facilities (range 16-133 samples), were identified. All but one were single-centre studies. Studies were of low to moderate quality. Overall, there was no statistically significant difference between measured and prescribed DNa {mean difference = 0.73 mmol/L [95% confidence interval (CI) -1.12 to 2.58; P = 0.44]} but variability across studies was substantial (I2 = 99.3%). Among individually reported samples (n = 295), measured DNa was higher than prescribed DNa by 1.96 mmol/L (95% CI 0.23-3.69) and the 95% limits of agreement ranged from -3.97 to 7.88 mmol/L. Regression analysis confirmed a strong relationship between prescribed and measured DNa, with a slope close to 1:1 (β = 1.16, 95% CI 1.06-1.27; P < 0.0001).

CONCLUSIONS

A limited number of studies suggest that, on average, prescribed and measured DNa are similar. However, between- and within-study differences were large. Further consideration of the precision of delivered DNa is required to inform rational prescribing.

Address: The George Institute for Global Health, UNSW Sydney, Sydney, Australia.; Department of Medicine & Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China.; Department of Renal Medicine, St George Hospital, Sydney, Australia.; Department of Medicine, Counties Manukau Health, Auckland, New Zealand.; Faculty of Medical and Health Sciences, School of Medicine, University of Auckland, Auckland, New Zealand.; Renal Division, University Hospital of Würzburg, Würzburg, Germany.; THE George Institute for Global Health India, UNSW, New Delhi, India.; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.; Australasian Kidney Trials Network, The University of Queensland, Australia.; University of Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France.; Medical Center Boulevard, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.; Laboratory of Renal Disease, Peking University Institute of Nephrology, Key Ministry of Health of China, Beijing, China.; Manipal Academy of Higher Education, Manipal, India.; The George Institute for Global Health, School of Public Health, Imperial College, London, UK.; Department of Nephrology, Monash Health and Monash University, Clayton, Victoria, Australia.; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.; Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, Australia.

DOI: 10.1093/ndt/gfaa287

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MeSH Terms: Dialysis Solutions, Humans, Prescriptions, Renal Dialysis, Sodium