Association of serum sodium levels with all‐cause and cardiovascular mortality in chronic kidney disease: Results from a prospective observational study

Chiu, Diana; Kalra, Philip A.; Sinha, Smeeta; Green, Darren

doi:10.1111/nep.12634

Cited by 26 publications

(35 citation statements)

References 28 publications

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“…These include changes of urine dilution and concentration in response to antidiuretic hormone, and alteration of water and Na and CI reabsorption and excretion 13,14 . Previous studies have reported that dysnatremias and hypochloremia are associated factors for mortality in patients with chronic kidney disease (CKD), with or without dialysis [15][16][17][18][19][20][21][22] . Thus, dyschloremias and dysnatremias have been proposed as potential useful factors for mortality prediction in this population [15][16][17][18][19][20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

Possible association between dysnatremias and mortality during hospitalization in patients undergoing acute hemodialysis: analysis from a Peruvian retrospective cohort

et al. 2019

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Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis.

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Section: Introductionmentioning

confidence: 99%

Possible association between dysnatremias and mortality during hospitalization in patients undergoing acute hemodialysis: analysis from a Peruvian retrospective cohort

et al. 2019

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“…Several 9 – 17 but not all 18 , 19 epidemiologic studies reported that hyponatremia is associated with increased all-cause mortality in no-dialysis CKD and maintenance dialysis patients. Similarly, the association of hypernatremia with all-cause mortality risk has also yielded inconsistent results 9 , 11 – 14 , 19 .…”

Section: Introductionmentioning

confidence: 99%

Association of serum sodium and risk of all-cause mortality in patients with chronic kidney disease: A meta-analysis and sysematic review

Sun

Hou

Xiao

et al. 2017

Sci Rep

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Studies on the association of dysnatraemia with all-cause mortality risk in chronic kidney disease (CKD) patients have yielded inconsistent results. This meta-analysis aimed to evaluate the association of hyponatremia or hypernatremia with all-cause mortality risk in CKD patients. An electronic literature search was performed in Web of Science, Pubmed and Embase databases from inception to March 2017 for available observational studies evaluating the association of dysnatraemia with all-cause mortality risk in CKD patients. Pooled hazard risk (HR) with 95% confidence interval (CI) was calculated for hyponatremia or hypernatremia vs. normonatremia. Seven studies that enrolled 742,979 CKD patients were identified. Baseline hyponatremia (HR 1.34; 95% CI: 1.15–1.57), and not hypernatremia (HR 1.12; 95%: CI 0.93–1.34), was independently associated with increased risk of all-cause mortality, when compared than the normonatremia category. In time-dependent analyses, both time-averaged hyponatremia (HR 1.65; 95% CI: 1.27–2.15) and hypernatremia (HR 1.41; 95% CI: 1.20–1.65) had a higher independent risk of all-cause mortality. Furthermore, subgroup analyses by type of patients, study design, sample size and follow-up duration revealed similar results across most of these analyses. Baseline hyponatremia and time-dependent hyponatremia or hypernatremia were independently associated with increased all-cause mortality risk in CKD patients.

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“…Another hypothesis is that hyponatremia may be associated with various medical conditions including bone fractures, falls [9,10], cardiovascular events [33], and cognitive dysfunction [3,34], eventually leading to a high mortality rate [29]. Our study showed that the lowest tertile of serum sodium had a higher proportion of comorbidities, although not statistically signi cantly.…”

Section: Discussionmentioning

confidence: 53%

Lower serum sodium level predicts poor clinical outcomes in patients with insomnia

Bae

Lee

Jang

et al. 2020

Preprint

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Background The association of lower serum sodium levels with clinical outcomes in insomnia patients remains unclear. We explored whether lower serum sodium is associated with poor clinical outcomes in patients with insomnia. Methods We retrospectively enrolled patients with a diagnosis of insomnia from January 2011 to December 2012. We divided participants into three groups according to initial serum sodium level: tertile 1 (< 138 mmol/L), tertile 2 (138.0–140.9 mmol/L), and tertile 3 (≥ 141.0 mmol/L). To calculate the relative risk of death, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox proportional hazard models. Result A total of 412 patients with insomnia were included, of whom 13.6% (n = 56) had hyponatremia. Patients with lower serum sodium concentrations were older and had lower hemoglobin, calcium, phosphorus, and albumin levels. At the median follow-up of 49.4 months, 44 patients had died and 62 experienced acute kidney injury (AKI). Kaplan-Meier analysis showed significantly higher mortality in patients in the lowest tertile for serum sodium. Lowest tertile of serum sodium, and AKI were associated with all-cause mortality. However, lowest tertile of serum sodium was not significantly associated with AKI. Conclusions The lowest tertile of serum sodium was associated with a higher mortality rate in insomnia patients. Our results suggest serum sodium level could be used one of the prognostic factor in insomniacs and physicians should be careful to take care of them when they present lower sodium level.

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Association of serum sodium levels with all‐cause and cardiovascular mortality in chronic kidney disease: Results from a prospective observational study

Abstract: Hyponatraemia in the ambulatory setting is associated with all-cause but not cardiovascular mortality in CKD, independent of concomitant medications and co-morbidities.

Cited by 26 publications

References 28 publications

Possible association between dysnatremias and mortality during hospitalization in patients undergoing acute hemodialysis: analysis from a Peruvian retrospective cohort

Possible association between dysnatremias and mortality during hospitalization in patients undergoing acute hemodialysis: analysis from a Peruvian retrospective cohort

Association of serum sodium and risk of all-cause mortality in patients with chronic kidney disease: A meta-analysis and sysematic review

Lower serum sodium level predicts poor clinical outcomes in patients with insomnia

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