Peritoneal dialysis: new developments and new problems

Aims To ascertain the incidence of hyponatraemia, and the impact of an icod extrin-based dialysis solution regime on hyponatraemia, in diabetic and non -diabetic patients using peritoneal dialysis (PD). Methods Following severe hyponatraemia, resulting in neurological sequelae, in two diabetic patients who were on icodextrin-based PD for established r enal failure, we reviewed the results of all our PD patients. Data was gath ered retrospectively, from our database and case notes, on plasma sodium, h aematocrit, dry weight estimation, plasma albumin and residual renal functi on. Patients using icodextrin-based solutions were compared with a random s election of patients using dextrose-based peritoneal solutions. We also com pared diabetic patients on and off icodextrin with their non-diabetic count erparts using the same dialysis regime. The data were analysed using the pa ired Student's t-test. Results Plasma sodium was significantly lower in all patients using icodext rin-based solutions compared with those patients on dextrose-based PD. Plas ma sodium was also found to fall in all patients following the initiation o f an icodextrin-based PD regime. The fall in plasma sodium was statisticall y significant in diabetic and non-diabetic patients, but only fell below th e laboratory reference range in the diabetic patients. Conclusions Icodextrin-based PD is a risk factor for hyponatraemia and may produce clinically relevant symptoms if, as in our two cases, the hyponatra emia is compounded by other factors.