Dialysate Sodium and Mortality

What is it about?

In a large, retrospective cohort of maintenance hemodialysis patients, Pinter et al. report a 43% lower risk of death in patients exposed to higher (>138 mmol/L) compared with those prescribed lower (≤138 mmol/L) dialysate sodium, regardless of plasma sodium levels. We think that these results, although new and probably unexpected, should be nuanced for the following reasons: 1- Fluid status was adequately controlled in both groups, which might favor survival in the higher dialysate group; 2-most participating centers used a fixed, default dialysate sodium, without individualization of dialysate sodium prescription; 3-the variability in dialysate sodium was to narrow (139-140 versus 138 mMol/L) to explain such a difference in survival.

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