Hyponatremia, Hypochloremia, and Hypoalbuminemia Predict an Increased Risk of Mortality During the First Year of Antiretroviral Therapy Among HIV-Infected Zambian and Kenyan Women

Dao, Christine N.; Peters, Philip J.; Kiarie, James; Zulu, Isaac; Muiruri, Peter; Ong’ech, John; Mutsotso, Winfred; Potter, Dara; Njobvu, Lungowe; Stringer, Jeffrey S. A.; Borkowf, Craig B.; Bolu, Omotayo; Weidle, Paul J.

doi:10.1089/aid.2010.0345

Cited by 32 publications

(34 citation statements)

References 29 publications

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“…We found that HIV patients with hyponatremia and who were at WHO clinical stage 4 had higher short-term mortality rates, which was similar to findings from previous studies (5,13,14). Hyponatremia is a common abnormality among HIV-infected adults with advanced HIV disease (15), and it was present in 28.4% of the hospitalized HIV patients in our study.…”

Section: Discussionsupporting

confidence: 91%

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

et al. 2014

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Objective Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper, we herein describe clinical characteristics, laboratory findings, causes of clinical deterioration, and risk factors associated with mortality among HIV-1 patients within six months after hospital admission. Methods We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality. Results A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis, tuberculosis, cytomegaloviremia, and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts, hypoalbuminemia, anemia, hyponatremia, as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ Tcell counts as well as low creatinine, hemoglobin, albumin, and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI), p=0.049], hyponatremia (OR: 3.027; 95% CI, p=0.015), and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI, 1.200-75.065; p=0.033) within the first six months of admission. Conclusion Special consideration should be given to patients who have active tuberculosis, are at clinical stage 4, and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.

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Section: Discussionsupporting

confidence: 91%

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

et al. 2014

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“…Dao et al . reported research indicating high mortality in the first year of initiating HAART in a population of African female patients with both hyponatremia and hypochloremia [14]. However, a number of issues remain to be clarified, such as whether hyponatremia independently influences the long-term survival of HIV/AIDS patients, the effect of serum sodium concentration on patient mortality, the relationship between serum sodium concentration, CD4+ cell counts, the severity of HIV/AIDS and the impact of hyponatremia on patient survival in other populations.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies by Dao et al . indicated that a serum sodium concentration below 135 mmol/L combined with hypochloremia lead to a high first year mortality in female AIDS patients [14]. However, further investigations are required to elucidate the relationships between serum sodium concentrations and CD4+ cell counts, WHO stages and HIV-RNA levels, and whether hyponatremia is an independent risk factor for death in HIV/AIDS patients.…”

Section: Introductionmentioning

confidence: 99%

Moderate/Severe Hyponatremia Increases the Risk of Death among Hospitalized Chinese Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients

Fan

et al. 2014

PLoS ONE

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ObjectivesTo evaluate whether the serum sodium concentration is associated with the progression and long-term prognosis of Chinese HIV/AIDS patients.MethodsThree hundred and eighty seven hospitalized patients were recruited into this retrospective cohort study. The strata of serum sodium concentration were moderate/severe hyponatremia, mild hyponatremia and normonatremia. Disease progression was estimated using CD4 counts and the WHO clinical stage. Correlation analysis was used to evaluate the serum sodium concentration with disease progression. The Kaplan-Meier method and the Cox proportional hazards model were used to analyze the effect of different serum sodium levels on survival.ResultsIn this study 206 patients (53.2%) had hyponatremia, including 10.6% patients with moderate/severe hyponatremia and 42.6% with mild hyponatremia. The serum sodium concentration was significantly correlated with the HIV/AIDS progression (P<0.001). During the follow-up, 100 patients (25.6%) died. The cumulative survival rates of HIV/AIDS patients were 47.8%±8.5% in patients with moderate/severe hyponatremia, 59.8%±5.0% with mild hyponatremia and 79.9%±3.4% with normonatremia (log-rank P<0.001). After adjusting for sex, age, WHO stage, CD4 count, hemoglobin and albumin, the relative hazard was 3.5 (95% CI: 1.9–6.5) for patients with moderate/severe hyponatremia (P<0.001), and 1.5 (95% CI: 0.9–2.4) for those with mild hyponatremia (P = 0.161), compared with normonatremic patients.ConclusionsThe serum sodium level is closely correlated with the severity of patients. Only moderate/severe hyponatremia affects the prognosis of Chinese HIV/AIDS patients. Earlier intensive medical managements(including HAART)are necessary to increase the survival rates of Chinese HIV/AIDS patients with moderate/severe hyponatremia.

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“…Numerous studies have examined the associations of serum albumin with adverse events in HIV-infected individuals 89101516 . However, no previous studies, to our knowledge, have evaluated the relationship between serum albumin and longitudinal kidney function in an HIV-infected population, and few have studied serum albumin and kidney disease in the general population 1117 .…”

Section: Discussionmentioning

confidence: 99%

Serum Albumin and Kidney Function Decline in HIV-Infected Women

Lang

Scherzer

Tien

et al. 2014

American Journal of Kidney Diseases

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Background Serum albumin concentrations are a strong predictor of mortality and cardiovascular disease in HIV-infected individuals. We studied the longitudinal associations between serum albumin levels and kidney function decline in a population of HIV-infected women. Study Design Retrospective cohort analysis. Setting & Participants The study participants were recruited from the Women’s Interagency HIV Study (WIHS), a large observational study designed to understand risk factors for the progression of HIV infection in women living in urban communities. 908 participants had baseline assessment of kidney function and two follow-up measures over an average of 8 years. Predictor The primary predictor was serum albumin concentration. Outcomes We examined annual change in kidney function. Secondary outcomes included rapid kidney function decline and incident reduced estimated glomerular filtration rate (eGFR). Measurements Kidney function decline was determined by cystatin C–based (eGFRcys) and creatinine-based eGFR (eGFRcr) at baseline and follow up. Each model was adjusted for kidney disease and HIV-related risk factors using linear and relative risk regression. Results After multivariate adjustment, each 0.5-g/dL decrement in baseline serum albumin concentration was associated with a 0.56-mL/min faster annual decline in eGFRcys (P<0.001), which was only slightly attenuated to 0.55-mL/min/1.73 m2 after adjustment for albuminuria. Results were similar whether using eGFRcys or eGFRcr. In adjusted analyses, each 0.5-g/dL lower baseline serum albumin was associated with a 1.71-fold greater risk of rapid kidney function decline (p<0.001) and a 1.72-fold greater risk of incident reduced eGFR (p<0.001). Limitations The cohort is composed of only female participants from urban communities within the United States. Conclusions Lower levels of serum albumin were strongly associated with kidney function decline and incident reduced eGFR in HIV-infected women, independent of HIV disease status, BMI and albuminuria.

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Hyponatremia, Hypochloremia, and Hypoalbuminemia Predict an Increased Risk of Mortality During the First Year of Antiretroviral Therapy Among HIV-Infected Zambian and Kenyan Women

Cited by 32 publications

References 29 publications

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

Moderate/Severe Hyponatremia Increases the Risk of Death among Hospitalized Chinese Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients

Serum Albumin and Kidney Function Decline in HIV-Infected Women

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