Hyponatremia and In‐Hospital Falls and Fractures in Older Adults

Dokmak, Amr; Madias, Nicolaos E.

doi:10.1111/jgs.15946

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…A higher serum sodium level is usually linked to poor blood pressure control and higher risk of cardiovascular events in the general population. Differently, lower serum sodium predicts poor clinical outcomes, particularly among at-risk populations such as young children [3,4], older adults [5][6][7], and hospital patients or those with pneumonia [8,9]. It has been demonstrated that in both hemodialysis and PD population, the level of serum sodium relates inversely to higher risk of all-cause mortality [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Age Difference in the Association between Hyponatremia and Infection-Related Mortality in Peritoneal Dialysis Patients

Qiu

Wang

et al. 2020

Blood Purif

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Objectives: This study aimed to examine the association of serum sodium with infection-related mortality and its age difference among continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 1,656 CAPD patients from January 2006 to December 2013 were included in this study. All patients were followed up until December 2018. Hyponatremia was defined as serum sodium < 135 mmol/L. Cox proportional hazards regression model was used to investigate the relationship between baseline serum sodium levels and infection-related mortality. Results: Participants were aged 47.5 ± 15.3 years, 666 (40.2%) patients were female. Glomerulonephritis was the main cause of end-stage renal disease (61.1%). After a median of 46 months of followup, 507 patients died. Among the deaths, 252 (49.7%) died from cardiovascular diseases, 105 (20.7%) from infections, and 150 (29.6%) from other causes. The overall infection-related mortality was 14.8 events per 1,000 patients-year, which was higher in patients aged ≥50 years than those younger than 50 years (28.3 vs. 5.3 events per 1,000 patients-year). In the entire cohort, hyponatremia at was not associated with infection-related (hazards ratios [HR] 1.66, 95% CI 0.91-3.02) and all-cause mortality (HR 1.14, 95% CI 0.83-1.57) after adjusting for potential confounders. There was a significant interaction by age of association of serum sodium with infection-related (p = 0.002) and all-cause (p = 0.0002) death. Age-stratified analysis showed that compared with control group, hyponatremia was independently related to increased risks of infection-related death, but not all-cause mortality in patients aged ≥50 years, with HR of 2.32 (95% CI 1.25-4.32) and 1.33 (95% CI 0.95-1.87), respectively. Conclusions: Hyponatremia was associated with increased risk of infection-related mortality in CAPD patients aged ≥50 years.

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Section: Introductionmentioning

confidence: 99%

Age Difference in the Association between Hyponatremia and Infection-Related Mortality in Peritoneal Dialysis Patients

Qiu

Wang

et al. 2020

Blood Purif

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“…37 In total, several studies have found an association of chronic, even mild, hyponatremia with gait impairment, attention deficits, and a high risk of falls, 1,2 suggesting that hyponatremia, regardless of severity, should be included in all fall risk assessment tools. 38 Correcting hyponatremia may be justified on the basis of lowering risk of falls, taking into consideration emerging evidence that normalization of sodium leads to improvement in gait and cognition. [35][36][37]…”

Section: Impact Of Chronic Hyponatremia On Gait and Risk Of Fallsmentioning

confidence: 99%

Association of hyponatremia with bone mineral density and fractures: a narrative review

Tzoulis,

Yavropoulou

2023

Therapeutic Advances in Endocrinology

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Recent studies suggest a possible association of hyponatremia with osteoporosis, falls and bone fractures. The objectives of this narrative review were to further explore this association and the related pathophysiological mechanisms and to suggest a practical approach to patients with osteoporosis or chronic hyponatremia in clinical practice. We conducted an extensive PubMed search until October 2022 with the combination of the following keywords: ‘hyponatremia’ or ‘sodium’ or ‘SIADH’ and ‘fractures’ or ‘bone’ or ‘osteoporosis’, as MeSH Terms. Review of numerous observational studies confirms a significant independent association of, even mild, hyponatremia with two- to three-fold increase in the occurrence of bone fractures. Hyponatremia is a risk factor for osteoporosis with a predilection to affect the hip, while the magnitude of association depends on the severity and chronicity of hyponatremia. Chronic hyponatremia also increases the risk for falls by inducing gait instability and neurocognitive deficits. Besides the detrimental impact of hyponatremia on bone mineral density and risk of falls, it also induces changes in bone quality. Emerging evidence suggests that acute hyponatremia shifts bone turnover dynamics towards less bone formation, while hyponatremia correction increases bone formation. The key unanswered question whether treatment of hyponatremia could improve osteoporosis and lower fracture risk highlights the need for prospective studies, evaluating the impact of sodium normalization on bone metabolism and occurrence of fractures. Recommendations for clinical approach should include measurement of serum sodium in all individuals with fracture or osteoporosis. Also, hyponatremia, as an independent risk factor for fracture, should be taken into consideration when estimating the likelihood for future fragility fracture and in clinical decision-making about pharmacological therapy of osteoporosis. Until it is proven that normalization of sodium can lower fracture occurrence, correcting hyponatremia cannot be universally recommended on this basis, but should be decided on a case-by-case basis.

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“…It is characterized by severe and often irreversible neurologic sequelae such as dysarthria, dysphagia, psychiatric disturbances, spastic paraplegia or quadriplegia, seizures, pseudobulbar palsy, and altered mental status. Symptoms of osmotic demyelination occur 4-6 days after rapid overcorrection [37] . Therefore, the overall goal of treatment should be to avoid increasing the serum sodium levels by more than 0.5 mEq/L/h (or 10 mEq/L/day) and 8 mEq per subsequent day [10,38] .…”

Section: Central Pontine Myelinolysismentioning

confidence: 99%

Recent advances in the management of hyponatremia in cancer patients

Khan¹,

Waguespack²,

Ahmed³

2019

JCMT

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Hyponatremia is the most frequently encountered electrolyte disorder in cancer patients and is usually multifactorial in its origin. In this review, we discuss the predisposing factors, pathophysiology, clinical symptomatology, and currently available diagnostic and therapeutic options for the management of hyponatremia. In addition to paraneoplastic syndromes, concurrent chemotherapy and comorbidities predispose oncology patients to the risk of hyponatremia. Initial symptoms and signs can be subtle and the prompt evaluation and initiation of treatment is of paramount importance to prevent neurocognitive and other complications. The syndrome of inappropriate antidiuresis (SIAD) is the most common cause of hyponatremia, and the use of serum and urine parameters that distinguish SIAD from other etiologies is discussed. Individualized treatment is preferred depending on the underlying cause and severity of hyponatremia. The treatment of hyponatremia is reviewed and the importance of avoiding rapid overcorrection of the sodium level to reduce the risk of osmotic demyelination syndrome is emphasized. Vasopressin receptor antagonists (vaptans) offer a direct approach to the management of euvolemic and hypervolemic hyponatremia, but the indications for their use and long-term safety need to be clarified. The treatment of hyponatremia is likely to reduce complications and improve survival in cancer patients.

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Hyponatremia and In‐Hospital Falls and Fractures in Older Adults

Cited by 6 publications

References 10 publications

Age Difference in the Association between Hyponatremia and Infection-Related Mortality in Peritoneal Dialysis Patients

Age Difference in the Association between Hyponatremia and Infection-Related Mortality in Peritoneal Dialysis Patients

Association of hyponatremia with bone mineral density and fractures: a narrative review

Recent advances in the management of hyponatremia in cancer patients

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