Pérez-García Rafael, Palomares Inés, Merello José Ignacio, Ramos Rosa, Maduell Francisco, Molina Manolo, Aljama Pedro, Marcelli Daniele
Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España.
NephroCare Medical Management, Fresenius Medical Care, Madrid, España.
Nefrologia. 2016;36(1):42-50. doi: 10.1016/j.nefro.2015.10.005. Epub 2015 Dec 3.
As in the general population, in patients on haemodialysis (HD) hyponatraemia is associated with higher mortality risk. The objective of this article was to study the relationship between predialysis serum sodium (sNa) and mortality in an HD population. We also intended to define hyponatraemia and determine the characteristics of hyponatraemic patients in terms of anthropometric data, analytical features, dialysis measurements and hydration (bioimpedance).
Observational, descriptive study of a cohort of HD incident patients. The independent variable was the mean of each patient's sNa analysed during their first 6 months on HD.
A total of 4,153 patients were included in the study. Mean age was 64.7 years; 65.2% of the patients were male and 35% were diabetics. Mean follow-up time was 21.48 (SD) (1.31) months. sNa had a normal distribution, with a mean (SD)=138.46 (2.7) mEq/l. Body weight, diabetes mellitus, systolic blood pressure, interdialytic weight gain, total ultrafiltration, serum glucose, albumin and creatinine, vascular access and haemodialysis type, acquire significant differences between sodium quartiles. Lean tissue index (LTI) in patients with low serum sodium, Q1 (135 mEq/l), was significantly lower than the LTI of patients from the other serum sodium quartiles. Patients with sNa<136 mEq/l had a higher independent mortality risk (OR=1.62) (Cox regression analysis).
HD patients with hyponatraemia patients have a poor prognosis and present malnutrition or fluid overload.
与普通人群一样，血液透析（HD）患者的低钠血症与较高的死亡风险相关。本文的目的是研究HD人群透析前血清钠（sNa）与死亡率之间的关系。我们还旨在定义低钠血症，并根据人体测量数据、分析特征、透析测量和水合作用（生物电阻抗）确定低钠血症患者的特征。
对一组HD初治患者进行观察性、描述性研究。自变量是每位患者在HD治疗的前6个月期间分析的sNa平均值。
共有4153例患者纳入研究。平均年龄为64.7岁；65.2%的患者为男性，35%为糖尿病患者。平均随访时间为21.48（标准差）（1.31）个月。sNa呈正态分布，平均值（标准差）=138.46（2.7）mEq/L。体重、糖尿病、收缩压、透析间期体重增加、总超滤量、血糖、白蛋白和肌酐、血管通路和血液透析类型在钠四分位数之间存在显著差异。血清钠水平低的患者，即第一四分位数（Q1，<135 mEq/L），其瘦组织指数（LTI）显著低于其他血清钠四分位数的患者。sNa<136 mEq/L的患者具有更高的独立死亡风险（OR=1.62）（Cox回归分析）。
低钠血症的HD患者预后较差，存在营养不良或液体过载。
