Division of Nephrology, Salem Veterans Affairs Medical Center, 1970 Roanoke Blvd, Salem, VA 24153, USA.
Circulation. 2012 Feb 7;125(5):677-84. doi: 10.1161/CIRCULATIONAHA.111.065391. Epub 2012 Jan 5.
Hyponatremia is common in patients with conditions such as congestive heart failure and is associated with increased mortality in hospitalized patients. Congestive heart failure is common in patients with chronic kidney disease, but the association of serum sodium concentration with mortality in such patients is not well characterized.
We examined the association of serum sodium concentration with all-cause mortality in a nationally representative cohort of 655 493 US veterans with non-dialysis-dependent chronic kidney disease (95 961 [15%] of them with congestive heart failure). Associations were examined in time-dependent Cox models with adjustment for potential confounders. During a median follow-up of 5.5 years, a total of 193 956 patients died (mortality rate, 62.5/1000 patient-years; 95% confidence interval, 62.2-62.8). The association of serum sodium level with mortality was U-shaped, with the lowest mortality seen in patients with sodium level of 140 mEq/L and with both lower and higher levels showing significant associations with increased mortality. Patients with serum sodium levels of <130, 130 to 135.9, 145.1 to 150, and ≥150 mEq/L compared with 136 to 145 mEq/L had multivariable-adjusted mortality hazard ratios (95% confidence interval) of 1.93 (1.83-2.03), 1.28 (1.26-1.30), 1.33 (1.28-1.38), and 1.56 (1.33-1.83) (P<0.001 for all). The associations remained consistent in subgroups of patients with and without congestive heart failure.
Both lower and higher serum sodium levels are independently associated with higher mortality in patients with non-dialysis-dependent chronic kidney disease, irrespective of the presence or absence of congestive heart failure.
低钠血症在充血性心力衰竭等疾病患者中很常见，与住院患者的死亡率增加有关。充血性心力衰竭在慢性肾脏病患者中很常见，但血清钠浓度与此类患者死亡率的关系尚不清楚。
我们在一个由 655493 名美国非透析依赖性慢性肾脏病退伍军人组成的全国代表性队列中，检查了血清钠浓度与所有原因死亡率的关系（其中 95961 名[15%]患有充血性心力衰竭）。在时间依赖性 Cox 模型中，根据潜在的混杂因素进行调整，对相关性进行了检验。在中位随访 5.5 年期间，共有 193956 名患者死亡（死亡率为 62.5/1000 患者年；95%置信区间，62.2-62.8）。血清钠水平与死亡率的关系呈 U 形，血清钠水平为 140mEq/L 的患者死亡率最低，而血清钠水平较低和较高的患者与死亡率升高均显著相关。与 136 至 145mEq/L 相比，血清钠水平<130、130 至 135.9、145.1 至 150 和≥150mEq/L 的患者校正后的多变量死亡率危险比（95%置信区间）分别为 1.93（1.83-2.03）、1.28（1.26-1.30）、1.33（1.28-1.38）和 1.56（1.33-1.83）（所有 P<0.001）。在有或没有充血性心力衰竭的患者亚组中，这些关联仍然一致。
在非透析依赖性慢性肾脏病患者中，血清钠水平较低和较高均与死亡率升高独立相关，无论是否存在充血性心力衰竭。
