Outcomes of Hospital-Acquired Hypernatremia

Abstract

Background Hospital-acquired hypernatremia is highly prevalent, overlooked and is associated with unfavorable consequences. There are limited studies examining the outcomes and discharge dispositions of various levels of hospital-acquired hypernatremia in patients with or without chronic kidney disease. Methods We conducted an observational retrospective cohort study, and we analyzed the data of 1,728,141 million patients extracted from the Cerner Health Facts database (January 1st 2000- June 30th 2018). In this report we investigated the association between hospital-acquired hypernatremia (serum sodium (Na) levels>145 mEq/L) and in-hospital mortality or discharge dispositions with kidney function status at admission using adjusted multinomial regression models. Results Of all hospitalized patients, 6% developed hypernatremia after hospital admission. Incidence of in-hospital mortality was 12% and 1% in hyper- and normonatremic patients, respectively. The risk of all outcomes was significantly greater for serum Na >145 mEq/L compared to the reference interval (serum Na: 135-145 mEq/L). In hypernatremic patients, odds ratios (ORs) (95% confidence interval) for in-hospital mortality, discharge to hospice and discharge to nursing facilities were 14.04 (13.71-14.38), 4.35 (4.14-4.57) and 3.88 (3.82-3.94), respectively (p<0.001, for all). Patients with estimated glomerular filtration rate (CKD-EPI) 60-89 mL/min/1.73 m2 and normonatremia had the lowest OR for in-hospital mortality (1.60 [1.52-1.70]) Conclusions Hospital-acquired hypernatremia is associated with in-hospital mortality as well as discharge to hospice or to nursing facility in all stages of CKD.

Incident Hypernatremia in Hospitalized Patients

“…3 In addition, the vast majority of patients with hospital-acquired hypernatremia have impaired kidney concentrating capacity (primarily due to diuretics or osmotic diuresis) or increased extrarenal fluid losses (enteral and insensible). 3 In the study by Arzhan et al, 4 published in this issue of CJASN, the authors studied more than 1.7 million patients using the Cerner Health Facts national clinical database and examined hypernatremia severity as a graded exposure and conducted thorough analyses considering categories of acute and chronic kidney dysfunction. They examined these exposures and assessed the odds of in-hospital mortality, discharge to hospice, and discharge to a nursing facility compared with patients who remained normonatremic throughout hospitalization.…”