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Meta-Analysis
. 2019 Apr;32(2):231-239.
doi: 10.1007/s40620-018-0507-1. Epub 2018 Jul 5.

Sodium removal by peritoneal dialysis: a systematic review and meta-analysis

Silvio Borrelli  1 , Vincenzo La Milia  2 , Luca De Nicola  3 , Gianfranca Cabiddu  4 , Roberto Russo  5 , Michele Provenzano  3 , Roberto Minutolo  3 , Giuseppe Conte  3 , Carlo Garofalo  3 ; Study group Peritoneal Dialysis of Italian Society of Nephrology
Affiliations
Meta-Analysis

Sodium removal by peritoneal dialysis: a systematic review and meta-analysis

Silvio Borrelli et al. J Nephrol. 2019 Apr.

Abstract

Achievement of sodium and fluid balance is considered a major determinant of dialysis adequacy in peritoneal dialysis (PD). However, the contribution of different PD modalities to dialytic sodium removal (DSR) remains ill-defined. We performed a systematic review and meta-analysis to compare DSR by manual (continuous ambulatory PD, CAPD) versus automated PD (APD). Alternative PD strategies to remove sodium were also analyzed. Seven cohort studies, including 683 patients, 406 in CAPD and 277 in APD, were meta-analyzed out of the 30 studies selected based on DSR data availability. Overall, the unstandardized mean difference between CAPD and APD was significant [- 56 mmol/day (95% CI - 106, - 6), p = 0.027]. Heterogeneity was high (I2 87.2%; p < 0.001). Meta-regression showed a strict correlation of DSR difference with creatinine dialysate/plasma ratio (D/P) (p = 0.04). DSR was significantly lower in APD than CAPD [86.2 (57.3-115.1) vs. 141.3 (107.6-174.9) mmol/day, p = 0.015]. Conversely, ultrafiltration (UF) did not differ [1122.6 (891.2-1354.0) in CAPD and 893.6 (823.0-964.2) ml/day in APD, p = 0.064]. A very strong correlation between DSR and achieved UF was found in CAPD (R = 0.94; p < 0001) while no relationship was detected in APD (R = - 0.07; p = 0.85). CAPD allows a higher DSR than APD, even though UF is not different. APD removes more water than sodium; therefore, DSR should be measured rather than estimated from the achieved UF. The difference in DSR between the two modalities decreases in high transporters. Novel strategies proposed to increase DSR, e.g. lower sodium dialysate or adapted-APD, are promising, but ad hoc studies are necessary.

Keywords: Peritoneal dialysis; Sodium removal; Ultrafiltration.

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References

    1. Van Biesen W, Williams JD, Covic AC et al for the EuroBCM Study Group (2011) Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS One 6:e17148 - DOI - PubMed - PMC
    1. Paniagua R, Ventura MD, Avila-Diaz M et al (2010) NT-proBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients. Nephrol Dial Transplant 25:551–557 - DOI - PubMed
    1. Enia G, Mallamaci F, Benedetto FA et al (2001) The Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than hemodialysis patients. Nephrol Dial Transplant 16(7):1459–1464 - DOI - PubMed
    1. Van Biesen W, Heimburger O, Krediet R et al (2010) Evaluation of peritoneal membrane characteristics: clinical advice for prescription management by the ERBP working group. Nephrol Dial Transplant 25:2052–2062 - DOI - PubMed
    1. Ates K, Nergizoglu G, Keven K et al (2001) Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. Kidney Int 60:767–776 - DOI - PubMed