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. 2024 May 2;25(1):152.
doi: 10.1186/s12882-024-03586-y.

Association between serum sodium trajectory and mortality in patients with acute kidney injury: a retrospective cohort study

Shanhe Huang #  1 , Xiaojing Li #  2 , Baorong Chen #  3 , Yaqi Zhong  1 , Yuewei Li  4 , Tucheng Huang  5   6
Affiliations

Association between serum sodium trajectory and mortality in patients with acute kidney injury: a retrospective cohort study

Shanhe Huang et al. BMC Nephrol. .

Abstract

Introduction: Dysnatremia is strongly associated with poor prognosis in acute kidney injury (AKI); however, the impact of sodium trajectories on the prognosis of patients with AKI has not yet been well elucidated. This study aimed to assess the association between sodium trajectories in patients with AKI and mortality at 30-day and 1-year follow-up.

Methods: This retrospective cohort study used data from Medical Information Mart for Intensive Care (MIMIC)-IV database, and patients diagnosed with AKI within 48 h after admission were enrolled. Group-based trajectory models (GBTM) were applied to map the developmental course of the serum sodium fluctuations. Kaplan-Meier survival curve was used to compare differences in mortality in AKI patients with distinct serum sodium trajectories. Hazard ratios (HRs) were calculated to determine the association between trajectories and prognosis using Cox proportional hazard models.

Results: A total of 9,314 AKI patients were enrolled. Three distinct sodium trajectories were identified including: (i) stable group (ST, in which the serum sodium levels remained relatively stable, n = 4,935; 53.0%), (ii) descending group (DS, in which the serum sodium levels declined, n = 2,994; 32.15%) and (iii) ascending group (AS, in which the serum sodium levels were elevated, n = 1,383; 14.85%). There was no significant difference in age and gender distribution among the groups. The 30-day mortality rates were 7.9% in ST, 9.5% in DS and 16.6% in AS (p < 0.001). The results of 1-year mortality rates were similar (p < 0.001). In adjusted analysis, patients in the DS (HR = 1.22, 95% confidence interval [CI], 1.04-1.43, p = 0.015) and AS (HR = 1.68, 95% CI, 1.42-2.01, p = 0.013) groups had higher risks of 30-day mortality compared to those in the ST group.

Conclusion: In patients with AKI, the serum sodium trajectories were independently associated with 30-day and 1-year mortality. Association between serum sodium level trajectories and prognosis in patients with AKI deserve further study.

Keywords: Acute kidney injury; Cohort study; MIMIC database; Mortality; Serum sodium trajectory.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Identification of serum sodium trajectories. A The average Serum sodium level trajectories of patients in different group with acute kidney injury (AKI). B The mean serum sodium levels0 from day 1 to day 7 in each group
Fig. 2
Fig. 2
Flowchart depicting the inclusion of study population
Fig. 3
Fig. 3
Kaplan–Meier survival estimates of 30-day mortality among each serum sodium trajectory
See this image and copyright information in PMC

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