Baek Seon Ha, Kim Sejoong, Na Ki Young, Kim Suhnggwon, Chin Ho Jun
Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2018 Sep;33(5):970-979. doi: 10.3904/kjim.2016.296. Epub 2017 Oct 19.
BACKGROUND/AIMS: Predialysis hyponatremia has been recently reported to be associated with mortality in incident hemodialysis patients. However, whether hyponatremia is associated with unfavorable outcomes in elderly patients remains unknown. We hypothesized that nephrology referral inf luences hyponatremia, and aimed to define how nephrology referral affects the association between hyponatremia and mortality in the elderly.
We retrospectively assessed mortality in 599 incident hemodialysis patients aged ≥ 70 at a tertiary university hospital, between 2000 and 2010. We analyzed 90-day and 1-year all-cause mortality (ACM) in relation to predialysis serum sodium (sNa). We divided the patients into two groups according to predialysis glucose-corrected sNa: hyponatremia (< 135 mmol/L) and normonatremia (135 to 145 mmol/L).
Low estimated glomerular filtration rate, high phosphorus, low albumin, nonpreparation of arteriovenous fistula or graft, and late referral were associated with a low sNa in the elderly. Among 599 patients, 106 and 174 patients died at the 90-day and 1-year follow-ups, respectively. Each 10-mmol/L increase in predialysis sNa tended to be associated with lower 90-day and 1-year ACM. When patients were stratified by nephrology referral, hyponatremia was associated with increased mortality in early referral group (90-day ACM: hazard ratio [HR] = 2.335, p = 0.041; 1-year ACM: HR = 1.790, p = 0.024). However, hyponatremia was not associated with mortality in late referral group.
Predialysis hyponatremia at hemodialysis initiation is associated with late referra.
背景/目的：近期有报道称，透析前低钠血症与初诊血液透析患者的死亡率相关。然而，低钠血症是否与老年患者的不良预后相关仍不清楚。我们推测肾病转诊会影响低钠血症，并旨在明确肾病转诊如何影响老年患者低钠血症与死亡率之间的关联。
我们回顾性评估了2000年至2010年间在一所三级大学医院就诊的599例年龄≥70岁的初诊血液透析患者的死亡率。我们分析了与透析前血清钠（sNa）相关的90天和1年全因死亡率（ACM）。根据透析前校正葡萄糖后的sNa将患者分为两组：低钠血症（<135 mmol/L）和正常钠血症（135至145 mmol/L）。
估计肾小球滤过率低、磷高、白蛋白低、未准备动静脉内瘘或移植物以及转诊延迟与老年人的低sNa相关。在599例患者中，分别有106例和174例患者在90天和1年随访时死亡。透析前sNa每升高10 mmol/L，往往与较低的90天和1年ACM相关。当根据肾病转诊对患者进行分层时，低钠血症与早期转诊组的死亡率增加相关（90天ACM：风险比[HR]=2.335，p=0.041；1年ACM：HR=1.790，p=0.024）。然而，低钠血症与晚期转诊组的死亡率无关。
血液透析开始时的透析前低钠血症与转诊延迟相关。
