Dysnatremias in Patients With Kidney Disease

Combs, Sara; Berl, Tomás

doi:10.1053/j.ajkd.2013.09.017

Cited by 61 publications

(53 citation statements)

References 51 publications

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“…Whether hypo- and hypernatremia represent a marker for the severity of the underlying disease causing dysnatremia that results in poor patient outcomes in CKD patients has to be determined, but it is plausible. It also remains to be investigated whether more attention to the correction or improvement in serum sodium levels could improve patient outcomes [8], such as mortality and/or progression to ESRD.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort

et al. 2015

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Background: Chronic kidney disease (CKD) patients are prone to both hypo- and hypernatremia. Little has been published on the epidemiology of hypo- and hypernatremia in ambulatory patients with non-dialysis CKD. Methods: Data collected in two contemporaneous CKD cohort studies, the Renal Research Institute (RRI)-CKD study (n = 834) and the Study of Treatment of Renal Insufficiency: Data and Evaluation (STRIDE) (n = 1,348) were combined and analyzed to study the association between serum sodium (Na⁺) and clinical outcomes. Results: Baseline estimated glomerular filtration rate (eGFR) and Na⁺ were 26 ± 11 ml/min/1.73 m² and 140.2 ± 3.4 mEq/l, respectively. The prevalence of Na⁺ ≤135 mEq/l and ≥144 mEq/l was 6 and 16%, respectively. Higher baseline Na⁺ was significantly associated with male sex, older age, systolic blood pressure, BMI, serum albumin, presence of heart failure, and lower eGFR. The risk of end-stage renal disease (ESRD) was marginally significantly higher among patients with Na⁺ ≤135 mEq/l, compared with 140< Na⁺ <144 mEq/l (referent), in time-dependent models (adjusted hazard ratio, HR = 1.52, p = 0.06). Mortality risk was significantly greater at 135< Na⁺ ≤140 mEq/l (adjusted HR = 1.68, p = 0.02) and Na⁺ ≥144 mEq/l (adjusted HR = 2.01, p = 0.01). Conclusion: CKD patients with Na⁺ ≤135 mEq/l were at a higher risk for progression to ESRD, whereas both lower and higher Na⁺ levels were associated with a higher risk of mortality. While caring for CKD patients, greater attention to serum sodium levels by clinicians is warranted and could potentially help improve patient outcomes.

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Section: Strengths and Limitationsmentioning

confidence: 99%

“…Patients with CKD are prone to both hypo- and hypernatremia. This is fundamentally the result of progressive impairment of concentration and diluting capacity as kidney function declines [8]. Recently, Kovesdy et al reported an association between serum sodium (Na + ) levels and mortality in an elderly CKD population of US veterans [9].…”

Section: Introductionmentioning

confidence: 99%

Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort

et al. 2015

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“…Dysnatremias are associated with high mortality risk [2,32] regardless of the underlying disease and type of patients (ambulatory or hospitalized). This finding is also applicable to healthy individuals [33].…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms in the central nervous system (CNS), including acute and chronic symptoms, are the main manifestations of dysnatremias [1]. Occurrence of dysnatremias carries high morbidity and mortality risk in CKD population [2,3].…”

Section: Introductionmentioning

confidence: 99%

Increased Risk of Ischemic Stroke in Patients with Chronic Kidney Disease after Recurrent Dysnatremias: A Nationwide Population-Based Cohort Study

Chung¹,

Yu²,

Wu³

et al. 2018

Neuropsychiatry

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Dysnatremias are the common problems in chronic kidney disease (CKD) patients and associated with neurologic symptoms. Thus, the purpose of this study was to determine the association between dysnatremias (either hypernatremia or hyponatremia) and risk of stroke in CKD population. A retrospective cohort study was constructed using the claims data of the entire insured residents covered by Taiwan's universal health insurance from 2000 to 2011. Severe hyponatremia and hypernatremia are defined as the need of 3% sodium chloride treatment and the need of admission respectively. A total of 365 hyponatremia and 137 hypernatremia patients and 1983 matched comparisons were recruited. The incidence of stroke was defined using the International Classification of Diseases, 9th Revision, Clinical Modification. Cox proportional hazard regression and Kaplan-Meier curves were used for the analyses. In the analysis, CKD with dysnatremias were with more diabetes, heart failure, mental illness, liver cirrhosis, cancer history and diuretics treatment. Compared with comparisons, patients with dysnatremias, hyponatremia or hypernatremia patients had a 2.57 (95% CI: 1.91-3.46), 2.35 (95% CI: 1.67-3.29) and 3.35 (95% CI: 2.04-5.50) fold risks of stroke after adjusting for potential factors. There was similarly increased risk for ischemic stroke, but not for hemorrhagic stroke. In addition, patients with recurrent dysnatremias, the risk of stroke much increased ) for hyponatremia and 11.4 (95% CI: 5.66-23.1) for hypernatremia]. In conclusion, we suggest more intensive surveillance to prevent recurrent dysnatremias and ischemic stroke should be emphasized.

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“…However, the water excretion ability is preserved in mild-to-moderate renal disease, and a near to normal serum sodium concentration is usually maintained if water intake is not excessive [58]. Hyponatremia related to the impairment of renal function is often observed in liver diseases [59].…”

Section: Hyponatremia Due To Endocrine Disorders In Liver Disease Patmentioning

confidence: 99%

Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise

et al. 2016

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Hyponatremia (Na(+) <135 mmol/l) is the most common electrolyte disorder. Cirrhosis represents a rather frequent cause of hyponatremia mainly due to systemic and splanchnic vasodilation resulting in decreased effective arterial blood volume, which leads to excessive non-osmotic secretion of antidiuretic hormone. However, hyponatremia of multifactorial origin may be seen in patients with liver diseases. The review focuses on the factors and pathogenetic mechanisms of decreased sodium levels other than the hemodynamic compromise of cirrhosis in patients with liver diseases. The mechanisms and causal or contributing role of pseudohyponatremia, hyperglycemia, infections, drugs and toxins as well as of endocrine disorders, renal failure and cardiac disease in patients with liver disease are meticulously discussed. Hyponatremia of multifactorial origin is frequently observed in patients with liver diseases, and special efforts should be made to delineate the underlying causative and precipitating factors as well as the risk factors of the osmotic demyelination syndrome in order to properly manage this serious electrolyte disorder and avoid treatment pitfalls.

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Dysnatremias in Patients With Kidney Disease

Cited by 61 publications

References 51 publications

Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort

Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort

Increased Risk of Ischemic Stroke in Patients with Chronic Kidney Disease after Recurrent Dysnatremias: A Nationwide Population-Based Cohort Study

Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise

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