Low-Sodium Peritoneal Dialysis Solution (Na 126 mmol/L) for Enhanced Sodium Removal: A Multicenter Randomized Controlled Trial
In brief
Low-sodium dialysis solution raised daily sodium removal by 29 mmol
After 8 weeks, patients using the low-sodium solution for one daily exchange had daily peritoneal sodium removal increase by 28.7 mmol on average, while it fell by 6.3 mmol with standard solution. Dialysis adequacy and residual kidney function did not differ, but mild, reversible drug-related events, mainly low blood sodium, occurred; patients with better kidney function were overrepresented.
- Journal
- Kidney medicine (Q1)
- Published
- 7 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Masaaki Nakayama, Hiroaki Takahashi, Hideka Hosaka, Fumiyo Uosaki, Yasuhiko Ito, Hidetomo Nakamoto
- PMID
- 42959528
- DOI
- 10.1016/j.xkme.2026.101487
Why clinicians should know about it
- Picked for Nephrology (top studies of the week, 8 November 2026): Low‑sodium PD solution improves sodium removal
Abstract
RATIONALE & OBJECTIVE: Fluid overload is a major cause of treatment failure in patients receiving peritoneal dialysis (PD), and insufficient sodium removal is involved with this condition. This study evaluated the efficacy and safety of a novel low-sodium (LS) PD solution (Na 126 mmol/L, glucose 1.6%) combined with standard-sodium (SS) PD solutions as a new approach to enhance sodium removal. STUDY DESIGN & PARTICIPANTS: In this multicenter, double-blind, randomized, parallel-group study, outpatient PD patients at 20 facilities in Japan were randomly assigned (2:1) to the LS PD solution group or the SS PD solution group (Na 135 mmol/L, glucose 1.35%). EXPOSURE: The test solution replaced 1 daily exchange and was combined with at least 1 standard PD solution. Patients who met dose-escalation criteria at week 4 switched to twice-daily dosing. OUTCOMES: The primary outcome was the change in daily peritoneal sodium removal from baseline to week 8. Secondary outcomes included peritoneal sodium removal per bag exchange, total daily (peritoneal and urinary) sodium, water removal, and dialysis adequacy. ANALYTICAL APPROACH: Efficacy, including sodium removal in PD treatment, was analyzed in the full analysis set; safety was assessed in all patients. RESULTS: The mean change in daily peritoneal sodium removal was significantly higher in the LS PD solution group (n = 51, 28.7 ± 36.2 mmol/d) than in the SS PD solution group (n = 27, -6.3 ± 26.2 mmol/d; P < 0.001). Other outcomes showed no significant differences. Drug-related adverse events (mainly hyponatremia) were observed in the LS PD solution group; however, they were generally mild and completely reversible. LIMITATIONS: Participants with relatively preserved residual kidney function and incremental PD were overrepresented. CONCLUSIONS: The LS PD solution, when combined with standard PD solutions, increased sodium removal without compromising dialysis adequacy or residual kidney function.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.