Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Jan 5:17:2.
doi: 10.1186/s12882-015-0215-1.

Dysnatremia, its correction, and mortality in patients undergoing continuous renal replacement therapy: a prospective observational study

Seung Seok Han  1 , Eunjin Bae  1 , Dong Ki Kim  1   2 , Yon Su Kim  1   2 , Jin Suk Han  1   2 , Kwon Wook Joo  3   4
Affiliations
Observational Study

Dysnatremia, its correction, and mortality in patients undergoing continuous renal replacement therapy: a prospective observational study

Seung Seok Han et al. BMC Nephrol. .

Abstract

Background: Although dysnatremia has been reported to be correlated with mortality risk, this issue remains unresolved in patients undergoing continuous renal replacement therapy (CRRT). Furthermore, it has not been determined whether change in or correction of sodium is related to mortality risk in this subset.

Methods: A total of 569 patients were prospectively enrolled at the start of CRRT between May 2010 and September 2013. The patients were divided into 5 groups: normonatremia (135-145 mmol/L), mild hyponatremia (131.1-134.9 mmol/L), moderate to severe hyponatremia (115.4-131.0 mmol/L), mild hypernatremia (145.1-148.4 mmol/L), and moderate to severe hypernatremia (148.5-166.0 mmol/L). The non-linear relationship between sodium and mortality was initially explored. Subsequently, the odds ratios (ORs) for 30-day mortality were calculated after adjustment of multiple covariates.

Results: The relationship between baseline sodium and mortality was U-shaped. The mild hyponatremia, moderate to severe hyponatremia, and moderate to severe hypernatremia groups had greater ORs for mortality (1.65, 1.91, and 2.32, respectively) than the normonatremia group (all P values < 0.05). However, later sodium levels (24 and 72 h after CRRT) did not predict 30-day mortality. Furthermore, the changes in sodium over 24 or 72 h, including the appropriate correction of dysnatremia, did not show any relationships with mortality, irrespective of baseline sodium level.

Conclusions: Sodium level at the start of CRRT was a strong predictor of mortality. However, changes in sodium level and the degree of sodium correction were not associated with the mortality risk in the patients with CRRT.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Non-linear relationship between baseline sodium level and the predicted probability of 30-day mortality. The range area indicates 95 % confidence intervals. A histogram of the sodium level is also shown
Fig. 2
Fig. 2
Kaplan-Meier survival curves according to the presence of hyponatremia (a) or hypernatremia (b)
Fig. 3
Fig. 3
Non-linear relationship between baseline sodium level and the odds ratio of 30-day mortality after adjustment for multiple covariates. The range area indicates 95 % confidence intervals
Fig. 4
Fig. 4
Non-linear relationships between the adjusted odds ratio of 30-day mortality and changes in sodium in the normonatremia (a, b), hyponatremia (c, d), and hypernatremia (e, f) groups. Figures (a), (c), and (e) show the relationships with changes over 24 h. Figures (b), (d), and (f) show the relationships with changes over 72 h
See this image and copyright information in PMC

References

    1. Hoorn EJ, Zietse R. Hyponatremia and mortality: moving beyond associations. Am J Kidney Dis. 2013;62(1):139–49. doi: 10.1053/j.ajkd.2012.09.019. - DOI - PubMed
    1. Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. 2007;50(6):952–7. doi: 10.1053/j.ajkd.2007.08.016. - DOI - PubMed
    1. Aranyi Z, Kovacs T, Szirmai I, Vastagh I. Reversible nerve conduction slowing in hyponatremia. J Neurol. 2004;251(12):1532–3. doi: 10.1007/s00415-004-0574-1. - DOI - PubMed
    1. Kozeny GA, Murdock DK, Euler DE, Hano JE, Scanlon PJ, Bansal VK, et al. In vivo effects of acute changes in osmolality and sodium concentration on myocardial contractility. Am Heart J. 1985;109(2):290–6. doi: 10.1016/0002-8703(85)90596-4. - DOI - PubMed
    1. Mohammed AA, van Kimmenade RR, Richards M, Bayes-Genis A, Pinto Y, Moore SA, et al. Hyponatremia, natriuretic peptides, and outcomes in acutely decompensated heart failure: results from the International Collaborative of NT-proBNP Study. Circ Heart Fail. 2010;3(3):354–61. doi: 10.1161/CIRCHEARTFAILURE.109.915280. - DOI - PubMed

Publication types

LinkOut - more resources