Departments of Nuclear Medicine and Pharmacy, University Côte d'Azur, University Hospital of Nice, Nice, France,
Department of Nephrology, University Côte d'Azur, University Hospital of Nice, Nice, France.
Clin Interv Aging. 2019 Jan 30;14:225-229. doi: 10.2147/CIA.S158987. eCollection 2019.
Water balance disorders are associated with a high risk of death in elderly patients. The role of osmotic stress intensity and its direction toward hypo- or hypernatremia is a matter of controversy regarding patients' survival. The aims of this study were, first, to measure the frequency of cellular hydration disorders in patients over 75 years old hospitalized in nephrology department for reversible acute renal failure, and second, to compare the impact of hyperhydration and hypohydration on the risk of death at 6 months.
We retrospectively studied the data of 279 patients with chronic kidney disease (CKD), aged 75 years or older, with pre-renal azotemia who experienced dysnatremia. We classified them according to natremia levels and compared their outcome in univariate and multivariate analysis.
The patients were on average 83.2±5.4 years old. Among them, 128 were normonatremic, 82 were hyponatremic and 69 were hypernatremic. Osmotic stress intensity appreciated by the variation rate of natremia did not differ significantly between hyper- and hyponatremic patients. Patients had CKD stage 3B and 4 with acute kidney injury (AKI) of different severities. We observed that only hypernatremia was linked to death in the first 6 months following hospital discharge.
Hypernatremia is a strong predictor of fatal outcome in elderly patients suffering from chronic kidney impairment and referred for pre-renal azotemia.
水平衡紊乱与老年患者死亡风险增加相关。渗透压应激强度及其导致低钠血症或高钠血症的方向对患者生存的影响存在争议。本研究的目的首先是测量因可逆性急性肾衰竭而在肾病科住院的 75 岁以上患者的细胞水合紊乱的频率，其次是比较高渗血症和低渗血症对 6 个月内死亡风险的影响。
我们回顾性研究了 279 例患有慢性肾脏病（CKD）且年龄在 75 岁或以上、因肾前性氮质血症而出现电解质紊乱的患者的数据。我们根据血钠水平对他们进行分类，并在单变量和多变量分析中比较他们的结果。
患者平均年龄为 83.2±5.4 岁。其中 128 例血钠正常，82 例低钠血症，69 例高钠血症。通过血钠变化率评估的渗透压应激强度在高钠血症和低钠血症患者之间没有显著差异。患者患有 CKD 3B 和 4 期，伴有不同严重程度的急性肾损伤（AKI）。我们观察到，只有高钠血症与出院后 6 个月内的死亡有关。
高钠血症是慢性肾脏损害并伴有肾前性氮质血症的老年患者发生致命结局的一个强有力的预测因素。
