Riphagen Ineke J, Logtenberg Susan J J, Groenier Klaas H, van Hateren Kornelis J J, Landman Gijs W D, Struck Joachim, Navis Gerjan, Kootstra-Ros Jenny E, Kema Ido P, Bilo Henk J G, Kleefstra Nanne, Bakker Stephan J L
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Centre, Isala Clinics, Zwolle, The Netherlands.
Atherosclerosis. 2015 Sep;242(1):179-85. doi: 10.1016/j.atherosclerosis.2015.07.010. Epub 2015 Jul 8.
Hyponatremia has been associated with an increased mortality risk in the general population. Diabetes is a condition predisposing for elevated levels of arginine vasopressin (AVP) and heart failure, both common causes of hyponatremia. These factors, however, are also associated with an increased mortality risk. We aimed to investigate whether serum sodium is associated with cardiovascular and all-cause mortality in type 2 diabetes and whether these associations could be explained by copeptin, a surrogate for AVP, or NT-proBNP, a marker for heart failure.
Patients with type 2 diabetes participating in the observational ZODIAC study were included. Cox regression analyses were used to investigate the association of serum sodium with mortality.
We included 1068 patients (age 67 ± 12 years, 45% male, serum sodium 142 ± 3 mmol/L). After 15 years of follow-up, 519 patients (49%) died, with 225 cardiovascular deaths (21%). In univariable analyses, serum sodium, copeptin, and NT-proBNP were all significantly associated with cardiovascular and all-cause mortality. These associations remained significant after combination of these markers in a multivariable model. Serum sodium and NT-proBNP remained significantly associated with mortality after further adjustment for potential confounders, whereas copeptin lost significance after adjustment for SCr and ACR.
Low serum sodium was associated with an increased risk of cardiovascular and all-cause mortality in type 2 diabetes. Moreover, these associations were not explained by copeptin and NT-proBNP. Whether low serum sodium itself leads to poor outcome or is a marker for (unidentified) co-morbidity severity or use of specific medications remains to be elucidated.
低钠血症与普通人群死亡率升高相关。糖尿病是精氨酸加压素（AVP）水平升高及心力衰竭的诱发因素，二者均为低钠血症的常见病因。然而，这些因素也与死亡率升高有关。我们旨在研究血清钠是否与2型糖尿病患者的心血管疾病死亡率及全因死亡率相关，以及这些关联是否可以通过AVP的替代指标 copeptin或心力衰竭标志物NT-proBNP来解释。
纳入参与观察性ZODIAC研究的2型糖尿病患者。采用Cox回归分析研究血清钠与死亡率的关联。
我们纳入了1068例患者（年龄67±12岁，45%为男性，血清钠142±3 mmol/L）。随访15年后，519例患者（49%）死亡，其中225例为心血管疾病死亡（21%）。在单变量分析中，血清钠、copeptin和NT-proBNP均与心血管疾病死亡率及全因死亡率显著相关。在多变量模型中将这些标志物合并后，这些关联仍然显著。在进一步调整潜在混杂因素后，血清钠和NT-proBNP与死亡率仍显著相关，而copeptin在调整血清肌酐和尿白蛋白肌酐比值后失去显著性。
低血清钠与2型糖尿病患者心血管疾病死亡率及全因死亡率升高风险相关。此外，这些关联无法通过copeptin和NT-proBNP来解释。低血清钠本身是否导致不良结局，或是否是（未明确的）合并症严重程度或特定药物使用的标志物，仍有待阐明。
