Eun Jung Kim

Far-infrared (FIR) therapy has been proposed to improve vascular access flow (Qa) in maintenance hemodialysis patients with an arteriovenous fistula (AVF) or arteriovenous graft (AVG). However, vascular access blood flow measurements may be difficult to interpret because of within-patient measurement variability. We prospectively evaluated Qa changes after FIR therapy and applied minimal detectable change at the 95% confidence level (MDC95) to assess reliable response. Forty-two maintenance hemodialysis patients with AVF or AVG received FIR therapy during hemodialysis for 40 min per session, three times weekly, for 3 months. Baseline Qa was calculated from three repeated pre-treatment measurements. Mean Qa increased from 1,004.3 ± 451.1 to 1,159.9 ± 668.9 mL/min at 3 months; this difference was significant in paired analysis, but not in linear mixed-effects, non-parametric, average post-treatment, or outlier-excluded analyses. The global within-patient SD of baseline Qa was 248.34 mL/min, yielding an MDC95 threshold of 688.36 mL/min. Although 21 patients (50.0%) showed any average post-treatment Qa increase, only 1 (2.4%) met the global MDC95 criterion and 3 (7.1%) met individual MDC95 criteria. The nominally significant paired increase in Qa was not robust across mixed-effects and sensitivity analyses, and reliably detectable individual increases were uncommon after accounting for within-patient variability.

Background: Hyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection. Methods: We conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively. Results: Among the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110–115, 115–120, and 120–125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24–1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66–0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor. Conclusion: In treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.