Need for low sodium concentration and frequent cycles of 3.86% glucose solution in children treated with acute peritoneal dialysis.

In acute renal failure (ARF) in the setting of a pediatric intensive care unit, most authors report the use of frequent cycles of (often low-volume) high-glucose solutions. That approach results in appropriate H2O ultrafiltration, but not in appropriate sodium removal, as a consequence of the sieving coefficient of sodium. That in turn leads not only to inefficient treatment of intravascular fluid overload, but also frequently to hypernatremia. The problem can be resolved by the use of low-sodium (127 mmol/L) dialysis solution. In the present prospective study in children, we performed peritoneal dialysis using a pharmacy-made solution containing 127 mmol/L sodium and 3.86% glucose, comparing that solution with conventional glucose solution. We calculated the ultrafiltration rate and the sodium removal. We observed no statistical difference in ultrafiltration rate, but a significantly increased sodium extraction. Children with acute overload during ARF may benefit if low-sodium solution is used in place of conventional dialysate. A low-sodium solution does not attenuate the pure ultrafiltration rate, but does result in higher sodium extraction, reducing intravascular volume and plasma sodium levels.