Impact of hemodialysis on the concentrations of sodium and potassium during infusion of sodium thiosulfate using an In Vitro hemodialysis model


Autoři: Sagar U. Nigwekar aff001;  Amy Barton Pai aff002;  Bruce Mueller aff002;  Michael C. Dean aff002;  Gabrielle Costello aff002;  Craig R. Sherman aff003
Působiště autorů: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff001;  University of Michigan College of Pharmacy, Ann Arbor, MI, United States of America aff002;  Hope Pharmaceuticals, Scottsdale, AZ, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224767

Souhrn

Introduction

The purpose of this study was to evaluate the impact of hemodialysis on the concentrations of sodium and potassium in the blood when a 25 g dose of sodium thiosulfate injection is infused over 60 minutes in combination with hemodialysis.

Methods

Sodium thiosulfate (25 g) was prepared by diluting 100 mL of 250 mg/mL Sodium Thiosulfate Injection with 800 mL of 5% dextrose. This was added to the circulating blood surrogate solution at a rate of 15 mL/minute using an infusion pump of an in vitro model of dialysis machine. Serial samples were collected before the administration of the sodium thiosulfate solution, after 15 minutes, 30 minutes, and 60 minutes of infusion from pre-and post-dialyzer ports in both the dialysate circuit and the extracorporeal circuit.

Findings

The concentration of sodium thiosulfate in pre-dialyzer and post-dialyzer samples of the circulating blood surrogate solution peaked at 30 minutes and 15 minutes, respectively and then remained relatively unchanged during the remainder of the infusion. Mean sodium concentrations (mEq/L) in the circulating blood surrogate solution collected after exposure to a dialyzer were 103.2 ± 12.2, 114.2 ± 18.8, 117.2 ± 7.5, 93.5 ± 5.9 at 0, 15, 30, and 60 minutes, respectively (p = 0.248). Mean potassium concentrations (mEq/L) in the circulating blood surrogate solution collected after exposure to a dialyzer were 1.4 ± 0.3, 1.6 ± 0.3, 1.5 ± 0.1, 1.2 ± 0.1 at 0, 15, 30, and 60 minutes, respectively (p = 0.365). Sodium and potassium concentrations in dialysate increased marginally after exposure to the dialyzer.

Discussion

Our study demonstrates that neither potassium nor sodium accumulated in circulating blood surrogate solution when a dose of sodium thiosulfate was infused in conjunction with hemodialysis.

Klíčová slova:

Blood – Drug therapy – Flow rate – Glucose – Medical dialysis – Ultrafiltration – Thiosulfates – Cyanides


Zdroje

1. Morocco AP. Cyanides. Crit Care Clin. 2005;21(4):691–705, vi. doi: 10.1016/j.ccc.2005.06.002. 16168309.

2. Kales SN, Christiani DC. Acute chemical emergencies. N Engl J Med. 2004;350(8):800–8. doi: 10.1056/NEJMra030370. 14973213.

3. Nigwekar SU, Thadhani R, Brandenburg VM. Calciphylaxis. N Engl J Med. 2018;378(18):1704–14. doi: 10.1056/NEJMra1505292. 29719190.

4. Nigwekar SU, Brunelli SM, Meade D, Wang W, Hymes J, Lacson E Jr. Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol. 2013;8(7):1162–70. doi: 10.2215/CJN.09880912. 23520041; PubMed Central PMCID: PMC3700696.

5. Cicone JS, Petronis JB, Embert CD, Spector DA. Successful treatment of calciphylaxis with intravenous sodium thiosulfate. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2004;43(6):1104–8. doi: 10.1053/j.ajkd.2004.03.018 15168392.

6. Zitt E, Konig M, Vychytil A, Auinger M, Wallner M, Lingenhel G, et al. Use of sodium thiosulphate in a multi-interventional setting for the treatment of calciphylaxis in dialysis patients. Nephrol Dial Transplant. 2013;28(5):1232–40. doi: 10.1093/ndt/gfs548. 23291368.

7. Noureddine L, Landis M, Patel N, Moe SM. Efficacy of sodium thiosulfate for the treatment for calciphylaxis. Clin Nephrol. 2011;75(6):485–90. doi: 10.5414/cnp75485 21612750.

8. Peng T, Zhuo L, Wang Y, Jun M, Li G, Wang L, et al. Systematic review of sodium thiosulfate in treating calciphylaxis in chronic kidney disease patients. Nephrology (Carlton). 2018;23(7):669–75. doi: 10.1111/nep.13081. 28603903.

9. trial C. Calista Trial. https://clinicaltrials.gov/ct2/show/NCT03150420 2019 [April 20, 2019].

10. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/201444s000lbl.pdf [April 29, 2019].

11. Tanhehco YC, Berns JS. Red blood cell transfusion risks in patients with end-stage renal disease. Semin Dial. 2012;25(5):539–44. doi: 10.1111/j.1525-139X.2012.01089.x. 22686519; PubMed Central PMCID: PMC3676886.

12. Michael JM, Dorner I, Bruns D, Ladenson JH, Sherman LA. Potassium load in CPD-preserved whole blood and two types of packed red blood cells. Transfusion. 1975;15(2):144–9. doi: 10.1046/j.1537-2995.1975.15275122809.x 1118880.

13. Pani A, Floris M, Rosner MH, Ronco C. Hyperkalemia in hemodialysis patients. Semin Dial. 2014;27(6):571–6. doi: 10.1111/sdi.12272. 25039770.

14. Gharibian KN, Murthy VL, Mueller BA. Influence of hemodialysis on regadenoson clearance in an in vitro hemodialysis model. J Nucl Cardiol. 2018;25(1):234–9. doi: 10.1007/s12350-016-0667-0. 27632986.

15. Singh RP, Derendorf H, Ross EA. Simulation-based sodium thiosulfate dosing strategies for the treatment of calciphylaxis. Clin J Am Soc Nephrol. 2011;6(5):1155–9. doi: 10.2215/CJN.09671010. 21441129; PubMed Central PMCID: PMC3087783.

16. Hundemer GL, Fenves AZ, Phillips KM, Emmett M. Sodium Thiosulfate and the Anion Gap in Patients Treated by Hemodialysis. Am J Kidney Dis. 2016;68(3):499–500. doi: 10.1053/j.ajkd.2016.02.040. 26992479.


Článek vyšel v časopise

PLOS One


2019 Číslo 11