Plasma sodium and subclinical left atrial enlargement in chronic kidney disease

Wang, Angela Yee-Moon; Lu, Yao; Cheung, Sharon; Chan, Iris Hiu Shuen; Lam, Christopher Wai Kei

doi:10.1093/ndt/gfs588

Cited by 14 publications

(6 citation statements)

References 44 publications

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“…The prevalence of LV relaxation impairment was expected; however, the prevalence of LAE was surprisingly high in our patients without clinically evident cardiopathy, considering that volume overload contributes significantly to LAE in patients with LV diastolic dysfunction and that our patients were not overhydrated, as reflected in the bioelectrical impedance measurements. We found no differences in plasma sodium between patients with and without LAE unlike other studies that observed a positive relation between plasma sodium and subclinical LAE [14]. The prevalence of LAE in that study was even higher than in our patients despite a wider range of the glomerular filtration rate and a higher mean CrC than in our study.…”

Section: Discussioncontrasting

confidence: 94%

Lower Plasma Sodium Is Associated with a Microinflammatory State among Patients with Advanced Chronic Kidney Disease

Ortega¹,

Cobo²,

Rodríguez³

et al. 2014

Nephron Clin Pract

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Background/Aims: Lower serum sodium levels have been associated with increased mortality among patients with chronic kidney disease (CKD). Our aim was to analyze the independent factors associated with lower sodium levels among nondialysis patients with advanced CKD and to evaluate the evolution of these patients in comparison to those with higher plasma sodium over a 1-year period. Methods: We included 72 patients with CKD stages 4 and 5 without clinically evident cardiopathy or liver disease. Bioelectrical impedance and echocardiography were performed to analyze the possible relation between plasma sodium and volume status and subclinical left ventricular (LV) dysfunction. During follow-up, we compared the evolution of patients with lower baseline plasma sodium (low quartile: <138 mEq/l) with that of patients with higher levels over a 1-year period. Results: At baseline, the independent predictors of lower plasma sodium were C-reactive protein (CRP; OR 0.96; 95% CI 0.91-0.99) and body mass index (OR 0.89; 95% CI 0.78-0.99). An inverse correlation between plasma sodium and CRP was observed (r = -0.32; p = 0.01). Plasma sodium did not correlate with extracellular water and was not different between patients with or without echocardiographic data of LV dysfunction (p = 0.7). During follow-up, patients with lower sodium at baseline showed persistently lower sodium values (p = 0.04), higher CRP (p = 0.05), lower serum albumin (p < 0.01) and higher erythropoietin-stimulating agent resistance index (p = 0.05). Conclusions: Our results suggest an association between lower plasma sodium and a microinflammatory state among patients with advanced CKD. Inflammation could be an underlying confounding factor explaining the increased mortality in these patients.

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Section: Discussioncontrasting

confidence: 94%

Lower Plasma Sodium Is Associated with a Microinflammatory State among Patients with Advanced Chronic Kidney Disease

Ortega¹,

Cobo²,

Rodríguez³

et al. 2014

Nephron Clin Pract

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“…Our study also found that alcohol drinking and tobacco smoking, which are predictors of atrial fibrillation or other cardiovascular events [23][24][25], were not related to LA enlargement. Low plasma sodium, which was shown to be associated with LA dilation in chronic kidney disease [36], was not associated with LA enlargement in this study. This is probably due to the low prevalence of chronic kidney disease in our study as compared with a previous study [36].…”

Section: Discussioncontrasting

confidence: 56%

Factors influencing left atrial volume in a population with preserved ejection fraction: Left ventricular diastolic dysfunction or clinical factors?

Lee

Daimon

Nakao

et al. 2016

Journal of Cardiology

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“…Intriguingly, for the first time, a recent study on stage 3-5 CKD patients reported a very high prevalence of subclinical LA enlargement and a strong independent relationship between plasma sodium concentration and subclinical LA enlargement in this population [37]. There are still no clear clues for interpreting these stimulating findings, nonetheless they are of potential interest because alterations in plasma sodium are frequent in CKD patients and include hypernatraemia (serum Na >145 mmol/L) which developed at least once in 7% of CKD patients in a study with a 5-year follow-up [38,39].…”

Section: Inflammation and Left Atrial Enlargementmentioning

confidence: 69%

A look at the upper heart chamber: the left atrium in chronic kidney disease

Paoletti

Zoccali

2013

Nephrology Dialysis Transplantation

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Altered left ventricular (LV) mass and function are classical hallmarks of cardiomyopathy in chronic kidney disease (CKD). The left atrium (LA), a heart chamber exquisitely sensitive to volume overload and diastolic function, is an independent predictor of death and adverse cardiovascular (CV) events in high-risk patients such as those with hypertension and/or with heart failure. In this review we focus on the relationship of LA size with LV diastolic function, and the association between LA enlargement and CV and renal outcomes in patients with CKD, including patients with end-stage renal disease. Increased LA size emerges as a powerful predictor of mortality and major adverse CV events in both end-stage and early CKD, and some studies also show a close association between enlarged LA and renal disease progression. Secondary analyses of clinical trials suggest that the LA has the potential to be elected as a surrogate end point in CKD patients but the issue remains to be tested in specifically designed clinical studies.

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Plasma sodium and subclinical left atrial enlargement in chronic kidney disease

Cited by 14 publications

References 44 publications

Lower Plasma Sodium Is Associated with a Microinflammatory State among Patients with Advanced Chronic Kidney Disease

Lower Plasma Sodium Is Associated with a Microinflammatory State among Patients with Advanced Chronic Kidney Disease

Factors influencing left atrial volume in a population with preserved ejection fraction: Left ventricular diastolic dysfunction or clinical factors?

A look at the upper heart chamber: the left atrium in chronic kidney disease

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