Chiu Diana Yuan Yng, Kalra Philip A, Sinha Smeeta, Green Darren
Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford.
Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
Nephrology (Carlton). 2016 Jun;21(6):476-82. doi: 10.1111/nep.12634.
The prevalence of hyponatraemia in the outpatient setting has not been thoroughly explored, and little is known about the prognostic implication of dysnatraemia in chronic kidney disease (CKD) patients, in particular accommodating the effect of concurrent medications.
This is a prospective observational study of non-dialysis-dependent CKD patients managed in a nephrology clinic. Patients enrolled between 2002 and 2012 in the Chronic Renal Insufficiency Standards Implementation Study were assessed. Survival analyses were performed using baseline sodium and 12-month time-averaged sodium, with adjustment for co-morbid diseases, laboratory findings and concurrent medications.
At baseline (n = 2093), mean estimated glomerular filtration rate was 32.8 ± 15.9 ml/min per 1.73 m(2) , median age was 67 (interquartile range 56-75) years and median serum sodium concentration was 140 (138-142) mmol/l. After a follow up of 41 (18-67) months, there were 684 deaths, 174 from cardiovascular causes; 1925 time-averaged sodium values were analysed. In the Cox multivariate adjusted regression, baseline hyponatraemia, but not hypernatraemia, was independently associated with all-cause mortality (hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.02-1.78, P = 0.04, and HR 1.15, 95% CI 0.84-1.57, P = 0.39, respectively). This was similarly the case for time-averaged hyponatraemia and hypernatraemia (HR 2.15, 95% CI 1.59-2.91, P < 0.01, and HR 1.47, 95% CI 0.93-2.38, P = 0.10, respectively). However, the association of baseline and time-averaged hyponatraemia with cardiovascular mortality was not significant.
Hyponatraemia in the ambulatory setting is associated with all-cause but not cardiovascular mortality in CKD, independent of concomitant medications and co-morbidities.
门诊环境中低钠血症的患病率尚未得到充分研究，对于慢性肾脏病（CKD）患者中钠代谢异常的预后意义知之甚少，尤其是未考虑同时使用药物的影响。
这是一项对肾病门诊中未依赖透析的CKD患者进行的前瞻性观察性研究。对2002年至2012年期间纳入慢性肾功能不全标准实施研究的患者进行评估。使用基线钠水平和12个月时间平均钠水平进行生存分析，并对合并疾病、实验室检查结果和同时使用的药物进行校正。
基线时（n = 2093），平均估计肾小球滤过率为32.8±15.9 ml/min per 1.73 m²，年龄中位数为67（四分位间距56 - 75）岁，血清钠浓度中位数为140（138 - 142）mmol/L。随访41（18 - 67）个月后，有684例死亡，其中174例死于心血管原因；分析了1925个时间平均钠值。在Cox多变量校正回归中，基线低钠血症而非高钠血症与全因死亡率独立相关（风险比（HR）1.35，95%置信区间（CI）1.02 - 1.78，P = 0.04，以及HR 1.15，95% CI 0.84 - 1.57，P = 0.39）。时间平均低钠血症和高钠血症情况类似（HR 2.15，95% CI 1.59 - 2.91，P < 0.01，以及HR 1.47，95% CI 0.93 - 2.38，P = 0.10）。然而，基线和时间平均低钠血症与心血管死亡率的关联不显著。
门诊环境中的低钠血症与CKD患者的全因死亡率相关，但与心血管死亡率无关，且独立于同时使用的药物和合并疾病。
