Associations of dysnatremias with mortality in chronic kidney disease

Huang, Hai-Quan; Jolly, Stacey E.; Airy, Medha; Arrigain, Susana; Schold, Jesse D.; Nally, Joseph V.; Navaneethan, Sankar D.

doi:10.1093/ndt/gfw209

Cited by 22 publications

(40 citation statements)

References 40 publications

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“…Mortality increased significantly with severity of hyponatraemia; this has also been reported in other studies [14,29]. Serum sodium predicts mortality as shown in most studies [7,14,27]. Mortality was significantly higher among those with impaired consciousness.…”

Section: Discussionsupporting

confidence: 83%

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Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study

Tannor

Akumiah²,

Norman³

2019

AJN

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Introduction: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality. There is a paucity of data on hyponatraemia in Ghana. We set out to describe the prevalence of this condition, its associations and the outcomes in terms of in-hospital mortality and length of hospital stay. Methods: We conducted a retrospective study of all admissions from October 2017 to April 2018 on the medical ward at the Komfo Anokye Teaching Hospital (KATH). Demographic information, medical diagnoses as well as clinical and laboratory data were documented. Means (± standard deviation) were recorded for normally distributed data, whereas non-normally distributed data were recorded as medians [interquartile range (IQR)]. Chi-squared and Fisher's exact tests were used to test categorical variables. ANOVA and Kruskal-Wallis tests were used for the analysis of hyponatraemia severity; a p value of < 0.05 was considered statistically significant. Results: Within the study period, 406 patients with hyponatraemia were identified in 1477 medical admissions, a prevalence of 27.6%. Their mean age was 51.5 ± 19.0 years. There were 217 males (53.5%). The mean serum sodium was 128.7 ± 6.5 mmol/L. Two hundred and forty (59%) had mild hyponatraemia, 106 (26%) had moderate hyponatraemia and 60 (15%) had severe hyponatraemia. The most common associated medical conditions were infections (26%), chronic liver disease (17%), hyperglycaemia (17%), chronic kidney disease (16%) and chronic heart failure (8%). In-hospital mortality was 31.8% and varied with the severity of the hyponatremia. The median length of hospital stay was 7 days (IQR 4-10 days) and did not vary with the severity of hyponatraemia. Mortality was associated with serum sodium concentration (p = 0.007) and lower levels of consciousness (Glasgow Coma Scale, GCS, ≤ 13) at presentation (p < 0.001). Conclusions: Hyponatraemia is common in medical admissions in Ghana, and is mostly associated with infections, and chronic liver, kidney and heart diseases. It is associated with high in-hospital mortality, especially when hyponatraemia is more severe or accompanied by relatively low GCS scores.

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Section: Discussionsupporting

confidence: 83%

“…Chronic kidney disease is common in hospital admissions in Ghana and patients often present late, with advanced disease [26]. Hyponatraemia in CKD patients is associated with increased mortality [27].…”

Section: Discussionmentioning

confidence: 99%

Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study

Tannor

Akumiah²,

Norman³

2019

AJN

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“…Dysnatremia in CKD and ESRD has mortality significance. A U-shaped association between serum Na and mortality was found in both non-dialysis CKD [123,127] and dialysis patients [128,129]. The management of dysnatremia in CKD patients is similar to that for the general patients and should start with identifying and, if possible, correcting the underlying cause.…”

Section: Other Electrolyte Derangementsmentioning

confidence: 99%

Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure

Dhondup

Qian²

2017

Blood Purif

156

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The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field. Although electrolyte and acid-base derangements are significant causes of morbidity and mortality in CKD and end-stage renal disease patients, they can be effectively managed through a timely institution of combined preventive measures and pharmacological therapy. Exciting advances and several upcoming outcome trials will provide further information to guide treatment and improve patient outcomes.

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“…Hyponatremia is recognized as a risk factor in CKD patients [3][4][5][6][7][8]. However, is hyponatremia a direct cause of death in HD patients?…”

Section: Discussionmentioning

confidence: 99%

“…Low serum sodium concentration is related to mortality in not only HD patients [3], but also chronic kidney disease (CKD) [4,5] and peritoneal dialysis patients [6,7]. However, the reason why hyponatremia induces an increased mortality has yet to be fully examined [8].…”

Section: Introductionmentioning

confidence: 99%

Low serum sodium concentration is a prognostic factor related to current blood glucose level in stable hemodialysis patients: an observational study

et al. 2017

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Background: A lot of risk factors for mortality have been proposed in hemodialysis patients. However, most of the findings were derived from the analyses using all of the hemodialysis patients. What we really want to know is the prognostic factor in stable hemodialysis patients who have good activities of daily living, because it is difficult to estimate their prognosis by physical appearance. Methods: This is a 7-year observational study. The study involved registering 631 patients who had undergone hemodialysis for more than 1 year at enrollment and were still alive more than 1 year after it. Demographic and clinical data were collected to analyze the relationship with mortality. Moreover, the patients were age-stratified to investigate age-dependent prognostic factors.

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Associations of dysnatremias with mortality in chronic kidney disease

Cited by 22 publications

References 40 publications

Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study

Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study

Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure

Low serum sodium concentration is a prognostic factor related to current blood glucose level in stable hemodialysis patients: an observational study

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