Aratani Sae, Hara Masahiko, Nagahama Masahiko, Taki Fumika, Futatsuyama Miyuki, Tsuruoka Shuichi, Komatsu Yasuhiro
Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan.
Department of Nephrology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
BMC Nephrol. 2017 Oct 18;18(1):316. doi: 10.1186/s12882-017-0732-1.
Even with abundant evidence for osmotic demyelination in patients with hyponatremia, the risk factors for overcorrection have not been fully investigated. Therefore the purpose of this study is to clarify the risks for overcorrection during the treatment of chronic profound hyponatremia.
This is a single-center retrospective observational study. We enrolled 56 adult patients with a serum sodium (SNa) concentration of ≤125 mEq/L who were treated in an intensive care unit by nephrologists using a locally developed, fixed treatment algorithm between February 2012 and April 2014. The impact of patient parameters on the incidence of overcorrection was estimated using univariable and multivariable logistic regression models. Overcorrection was defined as an increase of SNa by >10 mEq/L and >18 mEq/L during the first 24 and 48 h, respectively.
The median age was 78 years, 48.2% were male, and 94.6% of the patients presented with symptoms associated with hyponatremia. The initial median SNa was 115 mEq/L (quartile, 111-119 mEq/L). A total of 11 (19.6%) patients met the criteria for overcorrection with 9 (16.0%) occurring at 24 h, 6 (10.7%) at 48 h, and 4 (7.1%) at both 24 and 48 h. However, none of these patients developed osmotic demyelination. Primary polydipsia, initial SNa, and early urine output were the significant risk factors for overcorrection on univariable analysis. Multivariable analysis revealed that the initial SNa had a statistically significant impact on the incidence of overcorrection with an adjusted odds ratio of 0.84 (95% confidence interval, 0.70-0.98; p = 0.037) for every 1 mEq/L increase. Additionaly, the increase in SNa during the first 4 h and early urine output were significantly higher in patients with overcorrection than in those without (p = 0.001 and 0.005, respectively).
An initial low level of SNa was associated with an increased risk of overcorrection in patients with profound hyponatremia. In this regard, the rapid increase in SNa during the first 4 h may play an important role.
尽管有大量证据表明低钠血症患者存在渗透性脱髓鞘，但对纠正过度的危险因素尚未进行充分研究。因此，本研究的目的是阐明慢性重度低钠血症治疗期间纠正过度的风险。
这是一项单中心回顾性观察研究。我们纳入了56例血清钠（SNa）浓度≤125 mEq/L的成年患者，这些患者于2012年2月至2014年4月在重症监护病房由肾病学家使用当地制定的固定治疗方案进行治疗。使用单变量和多变量逻辑回归模型评估患者参数对纠正过度发生率的影响。纠正过度定义为SNa在最初24小时内升高>10 mEq/L，在最初48小时内升高>18 mEq/L。
中位年龄为78岁，48.2%为男性，94.6%的患者出现与低钠血症相关的症状。初始中位SNa为115 mEq/L（四分位数间距，111 - 119 mEq/L）。共有11例（19.6%）患者符合纠正过度标准，其中9例（16.0%）发生在24小时，6例（10.7%）发生在48小时，4例（7.1%）在24小时和48小时均发生。然而，这些患者均未发生渗透性脱髓鞘。单变量分析显示，原发性烦渴、初始SNa和早期尿量是纠正过度的重要危险因素。多变量分析显示，初始SNa每升高1 mEq/L，对纠正过度发生率有统计学显著影响，调整后的优势比为0.84（95%置信区间，0.70 - 0.98；p = 0.037）。此外，纠正过度患者最初4小时内SNa的升高和早期尿量显著高于未纠正过度的患者（分别为p = 0.001和0.005）。
重度低钠血症患者初始SNa水平低与纠正过度风险增加相关。在这方面，最初4小时内SNa的快速升高可能起重要作用。
