Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

Arzhan, Soraya; Lew, Susie Q.; Ing, Todd S.; Tzamaloukas, Antonios H.; Unruh, Mark

doi:10.3389/fmed.2021.769287

Cited by 15 publications

(17 citation statements)

References 145 publications

(262 reference statements)

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“…The kidneys have the ability to modulate sodium and water excretion, and CKD is frequently complicated with hyponatraemia probably due to fluid overload or diuretic usage. Hyponatraemia in CKD is associated with a higher risk of CKD progression, cardiovascular events, hospitalization and increased mortality (60, 61). Hyperkalaemia was significantly associated with CKD progression on univariate analysis but this significance was lost on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

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Background: Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. Methodology: A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. Results: A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46 - 67) years, the median eGFR was 37 (32 -51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016 -0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7 – 14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95 % CI 2.8 - 368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6 - 230.1, P= 0.007), hypocalcaemia (OR 3.8, 95 % CI 1.0 - 14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8 - 23.6, P= 0.042), anaemia (OR 2.1, 95% CI 1.0 - 4.3, P= 0.048), diabetes mellitus (OR 1.8, 95 % CI 0.9 - 3.6, P = 0.047), elevated HbA1c (OR 1.8, 95 % CI 1.2 - 2.8, P = 0.007) and current smoking (OR 2.8, 95 % CI 0.9 - 8.6, P = 0.049). Conclusion: Our study identified a higher prevalence of progression of CKD in a prospective longitudinal study of black patients with CKD. Progression of CKD was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking. This is a call for nephrologists and clinicians to be vigilant in identifying CKD patients at risk of CKD progression at early stages as this would allow risk stratification to improve kidney disease outcomes.

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Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

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“…Cependant, la plupart des données suggèrent une prévalence approximative de 10 à 25 % en DP. (6). Aucune donnée n'est disponible concernant la prévalence de l'hyponatrémie en fonction de la cause chez les patients en DP.…”

Section: Incidence/prévalence De L'hyponatrémie En Dialyse Péritonéal...unclassified

“…En d'autres termes, la clairance de l'eau libre devient inefficace en cas d'IRC avancée, ce qui entraîne un risque accru d'hyponatrémie. (6).…”

Section: Bilan Hydrique Sans éLectrolyte Concentration D'urineunclassified

“…Ce phénomène est plus prédominant chez les patients en DP sans capacité de filtration rénale résiduelle. (6,(20)(21)(22). Ces patients ont donc une gamme limitée d'apports hydriques permettant une natrémie normale.…”

Section: Bilan Hydrique Sans éLectrolyte Concentration D'urineunclassified

“…Certaines conditions sont associées à une sécrétion non osmotique d'ADH conduisant à une hyponatrémie. Cependant, ce mécanisme est moins efficace chez les patients en DP en raison de l'isosthénurie (6)…”

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Hyponatremia in peritoneal dialysis patients

et al. 2022

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Hyponatremia is the most common disorder of body fluid and electrolyte balance encountered in clinical practice, and also in peritoneal dialysis (PD) population. Depending on the severity and the speed of drop in sodium concentration, the symptoms can vary from asymptomatic hyponatremia to mild and non-specific symptoms or severe and life-threatening situations. Hyponatremia is associated with high morbidity and mortality. Its pathophysiology is complex, specifically in patients undergoing PD. The etiological workup can be cumbersome but is of paramount importance for early and appropriate treatment. In this article, we review the clinical manifestations as well as the pathophysiology and the specific etiologies of hyponatremia in peritoneal dialysis patients, and we propose a diagnostic algorithm.

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Bilateral renal dysplasia in a ferret (Mustela putorius furo)

Gilbert,

Lennox,

Johnson‐Delaney

et al. 2024

Vet Record Case Reports

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Renal dysplasia is a histological diagnosis characterised by disorganised architecture of the renal cortex and medulla with disrupted nephron differentiation and primitive ducts surrounded by collarettes of the mesenchymal tissue. This condition has been reported once previously in ferrets as a component of multiple congenital abnormalities of the urogenital tract. A 1.5‐year‐old, male, neutered ferret was presented after being found minimally responsive under a fallen shelf in its enclosure. The ferret was obtunded, with mild intermittent muscle tremors and severe dehydration. Survey radiographs, including thoracic and abdominal ventrodorsal and right and left lateral views, were performed to assess for general trauma. The right renal silhouette was normal in size, and the left was moderately reduced. The capsular margins of both renal silhouettes were moderately undulating and mildly indistinct with perirenal retroperitoneal striations. No signs of trauma or other abnormalities were identified. Whole blood biochemical analysis demonstrated elevated creatinine, elevated blood urea nitrogen, hypernatraemia, hypercalcaemia, hyperphosphataemia and hyperproteinemia characterised by hyperalbuminemia and haemoconcentration. The hypernatraemia and mentation failed to improve with intravenous fluid therapy, and the ferret was euthanased. Bilateral renal dysplasia was confirmed via gross postmortem examination and histopathology.

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Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

Cited by 15 publications

References 145 publications

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Hyponatremia in peritoneal dialysis patients

Bilateral renal dysplasia in a ferret (Mustela putorius furo)

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