Bone Disease as a New Complication of Hyponatremia

Ayus, Juan Carlos; Moritz, Michael L.

doi:10.2215/cjn.09281209

Cited by 39 publications

(24 citation statements)

References 15 publications

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“…This discrepancy could be due to the larger number of patients in their study ( n = 491 vs. n = 334 in ours). Mild chronic hyponatremia should not be viewed as a benign condition [11] because it is caused by multiple comorbidities or pharmacologic treatments (e.g., antihypertensives, antidepressants, and antiepileptics), and can lead to several pathologies and even death, both in and out of hospital [6][7][8][24][25][26] . Even mild hyponatremia in the elderly should be considered a risk factor for falls [21] .…”

Section: Discussionmentioning

confidence: 99%

“…In approximately 50% of patients, chronic hyponatremia results from inappropriate antidiuretic hormone secretion [10] . Chronic mild hyponatremia is usually asymptomatic and is traditionally regarded as benign [11] . However, it is associated with a lower bone mineral content and density in nearly all regions of the hip, with more pronounced losses in the trochanteric and femoral neck regions [12] .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Hyponatremia in Elderly Patients with Hip Fractures: A Two-Year Study

Aicale

Tarantino²,

Maffulli³

2017

Med Princ Pract

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Objective: This study investigated the prevalence of hyponatremia in elderly patients (≥65 years old) with hip fractures. Subjects and Methods: All records containing clinical and laboratory data on the 334 elderly patients admitted to the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno, Italy, with hip fractures during 2014 and 2015, were retrieved from the hospital database. Patients were divided into 4 groups, according to their sex and the type of hip fracture. Sodium serum concentrations were retrieved from the medical records. Hyponatremia was defined as the presence of at least 1 episode of hyponatremia during the hospital stay. Results: Of 334 elderly patients, hyponatremia was found in 64 (19%). The prevalence of hyponatremia was 18% (28/157) for female patients with extracapsular proximal femoral fracture, 22% (17/79) for female patients with intracapsular proximal femoral fracture, 20% (12/60) for male patients with extracapsular proximal femoral fracture, and 18% (7/38) for male patients with intracapsular proximal femoral fracture. Conclusion: There was a high prevalence of hyponatremia in the elderly patients with hip fractures. Hence, serum sodium concentrations should be regularly assessed to prevent occurrence of hyponatremia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of Hyponatremia in Elderly Patients with Hip Fractures: A Two-Year Study

Aicale

Tarantino²,

Maffulli³

2017

Med Princ Pract

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“…For example, it is well known that severe hyponatremia is directly toxic to the brain, leading to cerebral edema and herniation, encephalopathy, seizure and coma [23][24][25]. However, even mild declines in serum sodium level can have adverse consequence upon the central nervous system, including disequilibrium, gait abnormalities, fall and fracture risk [1,[26][27][28][29]. Indeed, a recent cross-sectional study of 472 PD patients showed that hyponatremia was associated with cognitive impairment ascertained by various formal testing methods [4].…”

Section: Discussionmentioning

confidence: 99%

Serum sodium and mortality in a national peritoneal dialysis cohort

Ravel

Streja

Mehrotra

et al. 2016

Nephrol. Dial. Transplant.

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A B S T R A C TBackground: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo-and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients. Methods: We sought to examine the association of serum sodium over time and mortality among 4687 adult incident PD patients from a large US dialysis organization who underwent one or more serum sodium measurements within the first 3 months of dialysis over January 2007 to December 2011. We examined the association of time-dependent and baseline sodium with allcause mortality as a proxy of short-and long-term sodium-mortality associations, respectively. Hazard ratios were estimated using Cox models with three adjustment levels: minimally adjusted, case-mix adjusted, and case-mix þ laboratory adjusted. Results: In time-dependent analyses, sodium levels <140 mEq/ L were associated with incrementally higher death risk in casemix models (ref: 140 to <142 mEq/L); following laboratory covariate adjustment, associations between lower sodium and higher mortality remained significant for levels <136 mEq/L. In analyses using baseline values, sodium levels <140 mEq/L were associated with higher mortality risk across all models (ref: 140 to <142 mEq/L). Conclusions: In PD patients, lower time-dependent and baseline sodium levels were independently associated with higher death risk. Further studies are needed to determine whether correction of dysnatremia improves longevity in this population.

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“…First, both hypo-and hypernatremic patients may experience recurring alterations in their serum sodium and osmolarity induced by higher/lower dialysate sodium concentrations that may be directly harmful [11]. Second, hypo-and hypernatremia may lead to disequilibrium, gait disturbances, falls, fractures and subsequent death risk [4,[27][28][29][30]. Hyponatremia may further predispose to fracture risk by reducing bone mineral density, volume and metabolism [31,32].…”

Section: O R I G I N a L A R T I C L Ementioning

confidence: 99%

Pre-Dialysis Serum Sodium and Mortality in a National Incident Hemodialysis Cohort

2015

American Journal of Kidney Diseases

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A B S T R AC TBackground. A consistent association between low serum sodium measured at a single-point-in-time (baseline sodium) and higher mortality has been observed in hemodialysis patients. We hypothesized that both low and high time-varying sodium levels (sodium levels updated at quarterly intervals as a proxy of short-term exposure) are independently associated with higher death risk in hemodialysis patients. Methods. We examined the association of baseline and timevarying pre-dialysis serum sodium levels with all-cause mortality among adult incident hemodialysis patients receiving care from a large national dialysis organization during January 2007-December 2011. Hazard ratios were estimated using multivariable Cox models accounting for case-mix+laboratory covariates and incrementally adjusted for inter-dialytic weight gain, blood urea nitrogen and glucose. Results. Among 27 180 patients, a total of 7562 deaths were observed during 46 194 patient-years of follow-up. Median (IQR) at-risk time was 1.4 (0.6, 2.5) years. In baseline analyses adjusted for case-mix+laboratory results, sodium levels <138 mEq/L were associated with incrementally higher mortality risk, while the association of sodium levels ≥140 mEq/L with lower mortality reached statistical significance only for the highest level of pre-dialysis sodium (reference: 138-<140 mEq/L). In time-varying analyses, we observed a U-shaped association between sodium and mortality such that sodium levels <138 and ≥144 mEq/L were associated with higher mortality risk. Similar patterns were observed in models incrementally adjusted for inter-dialytic weight gain, blood urea nitrogen and glucose.

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Bone Disease as a New Complication of Hyponatremia

Cited by 39 publications

References 15 publications

Prevalence of Hyponatremia in Elderly Patients with Hip Fractures: A Two-Year Study

Prevalence of Hyponatremia in Elderly Patients with Hip Fractures: A Two-Year Study

Serum sodium and mortality in a national peritoneal dialysis cohort

Pre-Dialysis Serum Sodium and Mortality in a National Incident Hemodialysis Cohort

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