Continuous renal replacement therapy for hypernatremia_West China Medical Journal

Authors：

MA Feng , BAI Ming ,  SUN Shiren

Department of Nephrology, Xijing Hospital, Xi’an, Shaanxi 710032, P. R. China;

Corresponding author：

SUN Shiren, Email: ningsun@fmmu.edu.cn

Keywords：

Hypernatremia; Continuous renal replacement therapy; Reduction rate of serum sodium concentration

DOI：

10.7507/1002-0179.201806078

Video：

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Abstract Full text Figures/Tables Video References Cited by

Hypernatremia is one of the commonly syndromes in critically ill patients. Severe hypernatremia has a low incidence (0.6%–1.0%) but with a very high mortality (58%–87%). Conventional treatments include the limitation of sodium intake and the supplement of sodium free liquid according to the assessed water lost. The reduction rates of conventional treatments are commonly not effective enough to decrease the serum sodium concentration in severe euvolemic or hypervolemic hypernatremia patients. Continuous renal replacement therapy (CRRT) has been reported to be effective on the reduction of sodium level in severe hypernatremia patients. However, the evidences on the use of CRRT for hypernatremia are limited. Our present review summarizes the current evidences on the prevalence of hypernatremia, the outcome of hypernatremia patients, the conventional treatment of hypernatremia, and the advantages and indications of CRRT for the management of hypernatremia. Additionally, we introduce our experiences on the management of hypernatremia using CRRT as well.

Citation： MA Feng, BAI Ming, SUN Shiren. Continuous renal replacement therapy for hypernatremia. West China Medical Journal, 2018, 33(7): 887-891. doi: 10.7507/1002-0179.201806078 Copy

1.	Oude Lansink-Hartgring A, Hessels L, Weigel J, et al. Long-term changes in dysnatremia incidence in the ICU: a shift from hyponatremia to hypernatremia. Ann Intensive Care, 2016, 6(1): 22.
2.	Imaizumi T, Nakatochi M, Fujita Y, et al. The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: a single-centre cohort study in Japan. BMJ Open, 2017, 7(8): e016248.
3.	Jung WJ, Lee HJ, Park S, et al. Severity of community acquired hypernatremia is an Independent predictor of mortality. Intern Emerg Med, 2017, 12(7): 935-940.
4.	Hoorn EJ, Betjes MG, Weigel J, et al. Hypernatraemia in critically ill patients: too little water and too much salt. Nephrol Dial Transplant, 2008, 23(5): 1562-1568.
5.	Hu JC, Wang Y, Geng X, et al. Dysnatremia is an independent indicator of mortality in hospitalized patients. Med Sci Monit, 2017, 23: 2408-2425.
6.	Alansari MA, Abdulmomen A, Hussein M, et al. Acquired hypernatremia in a general surgical intensive care unit: incidence and prognosis. Saudi J Anaesth, 2016, 10(4): 409-413.
7.	Waite MD, Fuhrman SA, Badawi O, et al. Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care, 2013, 28(4): 405-412.
8.	Ma F, Bai M, Li Y, et al. Continuous venovenous hemofiltration (CVVH) versus conventional treatment for acute severe hypernatremia in critically ill patients: a retrospective study. Shock, 2015, 44(5): 445-451.
9.	Ma F, Liu Y, Bai M, et al. The reduction rate of serum sodium and mortality in patients undergoing continuous venovenous hemofiltration for acute severe hypernatremia. Am J Med Sci, 2016, 352(3): 272-279.
10.	Lansink AO, Fahrentholz S, Nijsten MW. Risk of severe hypernatremia depends on underlying cause in critically ill patients. J Crit Care, 2013, 28(2): 213.
11.	Kumar S, Berl T. Sodium. Lancet, 1998, 352(9123): 220-228.
12.	Al-Absi A, Gosmanova EO, Wall BM. A clinical approach to the treatment of chronic hypernatremia. Am J Kidney Dis, 2012, 60(6): 1032-1038.
13.	Bataille S, Baralla C, Torro D, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol, 2014, 15: 37.
14.	Leung AA, Mcalister FA, Finlayson SR, et al. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med, 2013, 126(10): 877-886.
15.	Jepsen DB, Ryg J, Masud T, et al. Increased mortality in geriatric patients with hospital-acquired hypernatremia. Am J Med, 2013, 126(6): e13-e14.
16.	Alharfi IM, Stewart TC, Kelly SH, et al. Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury. J Neurotrauma, 2013, 30(5): 361-366.
17.	Arora SK. Hypernatremic disorders in the intensive care unit. J Intensive Care Med, 2013, 28(1): 37-45.
18.	Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med, 2000, 342(20):1493-1499.
19.	Ismail FY, Szóllics A, Szólics M, et al. Clinical semiology and neuroradiologic correlates of acute hypernatremic osmotic challenge in adults: a literature review. AJNR Am J Neuroradiol, 2013, 34(12): 2225-2232.
20.	Aiyagari V, Deibert E, Diringer MN. Hypernatremia in the neurologic intensive care unit: how high is too high?. J Crit Care, 2006, 21(2): 163-172.
21.	Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
22.	Kovesdy CP. Significance of hypo- and hypernatremia in chronic kidney disease. Nephrol Dial Transplant, 2012, 27(3): 891-898.
23.	Harring TR, Deal NS, Kuo DC. Disorders of sodium and water balance. Emerg Med Clin North Am, 2014, 32(2): 379-401.
24.	Sterns RH. Disorders of plasma sodium: causes, consequences, and correction. N Engl J Med, 2015, 372(1): 55-65.
25.	Lindner G, Funk GC, Lassnigg A, et al. Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med, 2010, 36(10): 1718-1723.
26.	Alshayeb HM, Showkat A, Babar F, et al. Severe hypernatremia correction rate and mortality in hospitalized patients. Am J Med Sci, 2011, 341(5): 356-360.
27.	Darmon M, Pichon M, Schwebel C, et al. Influence of early dysnatremia correction on survival of critically ill patients. Shock, 2014, 41(5): 394-399.
28.	Yang YF, Wu VC, Huang CC. Successful management of extreme hypernatraemia by haemofiltration in a patient with severe metabolic acidosis and renal failure. Nephrol Dial Transplant, 2005, 20(9): 2013-2014.
29.	Park HS, Hong YA, Kim HG, et al. Usefulness of continuous renal replacement therapy for correcting hypernatremia in a patient with severe congestive heart failure. Hemodial Int, 2012, 16(4): 559-563.
30.	Moss GD, Primavesi RJ, Mcgraw ME, et al. Correction of hypernatraemia with continuous arteriovenous haemodiafiltration. Arch Dis Child, 1990, 65(6): 628-630.
31.	Lin JJ, Mckenney DW, Price C, et al. Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma. Pediatr Nephrol, 2002, 17(11): 969-973.
32.	陈立平, 黄小萍, 周巧玲, 等. 连续性静脉-静脉血液滤过治疗急性高钠血症. 中南大学学报: 医学版, 2006, 31(6): 934-935.
33.	孙小伟, 李军荣. CRRT治疗脑出血合并高钠血症的疗效观察. 中风与神经疾病杂志, 2009, 26(1): 47-48.
34.	赵浪平, 周嘉敏, 张国斌, 等. 血液净化对重型颅脑损伤合并高钠血症的疗效. 广东医学, 2014, 35(8): 1216-1217.
35.	Huang C, Zhang P, Du R, et al. Treatment of acute hypernatremia in severely burned patients using continuous veno-venous hemofiltration with gradient sodium replacement fluid: a report of nine cases. Intensive Care Med, 2013, 39(8): 1495-1496.
36.	Rewa OG, Villeneuve PM, Lachance P, et al. Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review. Intensive Care Med, 2016, 43(6): 750-763.
37.	丁峰, 张明, 顾勇, 等. 不同方式连续性肾脏替代疗法对溶质清除率的影响. 复旦学报: 医学版, 2002, 29(4): 268-271.
38.	龚德华, 季大玺, 谢红浪, 等. 连续性肾脏替代治疗剂量对溶质清除率的影响. 中华内科杂志, 2001, 40(3): 183-186.

1. Oude Lansink-Hartgring A, Hessels L, Weigel J, et al. Long-term changes in dysnatremia incidence in the ICU: a shift from hyponatremia to hypernatremia. Ann Intensive Care, 2016, 6(1): 22.
2. Imaizumi T, Nakatochi M, Fujita Y, et al. The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: a single-centre cohort study in Japan. BMJ Open, 2017, 7(8): e016248.
3. Jung WJ, Lee HJ, Park S, et al. Severity of community acquired hypernatremia is an Independent predictor of mortality. Intern Emerg Med, 2017, 12(7): 935-940.
4. Hoorn EJ, Betjes MG, Weigel J, et al. Hypernatraemia in critically ill patients: too little water and too much salt. Nephrol Dial Transplant, 2008, 23(5): 1562-1568.
5. Hu JC, Wang Y, Geng X, et al. Dysnatremia is an independent indicator of mortality in hospitalized patients. Med Sci Monit, 2017, 23: 2408-2425.
6. Alansari MA, Abdulmomen A, Hussein M, et al. Acquired hypernatremia in a general surgical intensive care unit: incidence and prognosis. Saudi J Anaesth, 2016, 10(4): 409-413.
7. Waite MD, Fuhrman SA, Badawi O, et al. Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care, 2013, 28(4): 405-412.
8. Ma F, Bai M, Li Y, et al. Continuous venovenous hemofiltration (CVVH) versus conventional treatment for acute severe hypernatremia in critically ill patients: a retrospective study. Shock, 2015, 44(5): 445-451.
9. Ma F, Liu Y, Bai M, et al. The reduction rate of serum sodium and mortality in patients undergoing continuous venovenous hemofiltration for acute severe hypernatremia. Am J Med Sci, 2016, 352(3): 272-279.
10. Lansink AO, Fahrentholz S, Nijsten MW. Risk of severe hypernatremia depends on underlying cause in critically ill patients. J Crit Care, 2013, 28(2): 213.
11. Kumar S, Berl T. Sodium. Lancet, 1998, 352(9123): 220-228.
12. Al-Absi A, Gosmanova EO, Wall BM. A clinical approach to the treatment of chronic hypernatremia. Am J Kidney Dis, 2012, 60(6): 1032-1038.
13. Bataille S, Baralla C, Torro D, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol, 2014, 15: 37.
14. Leung AA, Mcalister FA, Finlayson SR, et al. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med, 2013, 126(10): 877-886.
15. Jepsen DB, Ryg J, Masud T, et al. Increased mortality in geriatric patients with hospital-acquired hypernatremia. Am J Med, 2013, 126(6): e13-e14.
16. Alharfi IM, Stewart TC, Kelly SH, et al. Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury. J Neurotrauma, 2013, 30(5): 361-366.
17. Arora SK. Hypernatremic disorders in the intensive care unit. J Intensive Care Med, 2013, 28(1): 37-45.
18. Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med, 2000, 342(20):1493-1499.
19. Ismail FY, Szóllics A, Szólics M, et al. Clinical semiology and neuroradiologic correlates of acute hypernatremic osmotic challenge in adults: a literature review. AJNR Am J Neuroradiol, 2013, 34(12): 2225-2232.
20. Aiyagari V, Deibert E, Diringer MN. Hypernatremia in the neurologic intensive care unit: how high is too high?. J Crit Care, 2006, 21(2): 163-172.
21. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
22. Kovesdy CP. Significance of hypo- and hypernatremia in chronic kidney disease. Nephrol Dial Transplant, 2012, 27(3): 891-898.
23. Harring TR, Deal NS, Kuo DC. Disorders of sodium and water balance. Emerg Med Clin North Am, 2014, 32(2): 379-401.
24. Sterns RH. Disorders of plasma sodium: causes, consequences, and correction. N Engl J Med, 2015, 372(1): 55-65.
25. Lindner G, Funk GC, Lassnigg A, et al. Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med, 2010, 36(10): 1718-1723.
26. Alshayeb HM, Showkat A, Babar F, et al. Severe hypernatremia correction rate and mortality in hospitalized patients. Am J Med Sci, 2011, 341(5): 356-360.
27. Darmon M, Pichon M, Schwebel C, et al. Influence of early dysnatremia correction on survival of critically ill patients. Shock, 2014, 41(5): 394-399.
28. Yang YF, Wu VC, Huang CC. Successful management of extreme hypernatraemia by haemofiltration in a patient with severe metabolic acidosis and renal failure. Nephrol Dial Transplant, 2005, 20(9): 2013-2014.
29. Park HS, Hong YA, Kim HG, et al. Usefulness of continuous renal replacement therapy for correcting hypernatremia in a patient with severe congestive heart failure. Hemodial Int, 2012, 16(4): 559-563.
30. Moss GD, Primavesi RJ, Mcgraw ME, et al. Correction of hypernatraemia with continuous arteriovenous haemodiafiltration. Arch Dis Child, 1990, 65(6): 628-630.
31. Lin JJ, Mckenney DW, Price C, et al. Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma. Pediatr Nephrol, 2002, 17(11): 969-973.
32. 陈立平, 黄小萍, 周巧玲, 等. 连续性静脉-静脉血液滤过治疗急性高钠血症. 中南大学学报: 医学版, 2006, 31(6): 934-935.
33. 孙小伟, 李军荣. CRRT治疗脑出血合并高钠血症的疗效观察. 中风与神经疾病杂志, 2009, 26(1): 47-48.
34. 赵浪平, 周嘉敏, 张国斌, 等. 血液净化对重型颅脑损伤合并高钠血症的疗效. 广东医学, 2014, 35(8): 1216-1217.
35. Huang C, Zhang P, Du R, et al. Treatment of acute hypernatremia in severely burned patients using continuous veno-venous hemofiltration with gradient sodium replacement fluid: a report of nine cases. Intensive Care Med, 2013, 39(8): 1495-1496.
36. Rewa OG, Villeneuve PM, Lachance P, et al. Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients: a systematic review. Intensive Care Med, 2016, 43(6): 750-763.
37. 丁峰, 张明, 顾勇, 等. 不同方式连续性肾脏替代疗法对溶质清除率的影响. 复旦学报: 医学版, 2002, 29(4): 268-271.
38. 龚德华, 季大玺, 谢红浪, 等. 连续性肾脏替代治疗剂量对溶质清除率的影响. 中华内科杂志, 2001, 40(3): 183-186.

West China Medical Journal

Continuous renal replacement therapy for hypernatremia

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