A standard hemodialysis prescription to prevent osmotic demyelination in hyponatremic patients requiring dialysis

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Abstract
Introduction: We aimed to investigate the effect of a standard hemodialysis prescription in hyponatremic patients requiring hemodialysis on the development of osmotic demyelination syndrome.Methods: Ninety‐nine patients who were treated with hemodialysis for the first time and had a pre‐dialysis sodium value of ≤125 meq/L included in the study. Standard hemodialysis treatment was applied to all patients. Biochemical data before, immediately after and 24 h after hemodialysis were recorded retrospectively. All patients followed up for 2 weeks and magnetic resonance imaging was performed in patients with neurological symptoms.Results: Eight patients had a sodium increase of more than 12 meq/L at 24‐h after hemodialysis. Although hyponatremia was corrected rapidly with hemodialysis, none of the 99 azotemic patients developed osmotic demyelination syndrome.Conclusion: We did not observe osmotic demyelination syndrome in hyponatremic patients with azotemia treated with standard protocol hemodialysis. However, caution should still be exercised in high‐risk patients for osmotic demyelination.

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