Department of Urology, University Hospital Center Split, Split, Croatia.
Department of Neurosurgery, University Hospital Center Split, Split, Croatia.
Wien Klin Wochenschr. 2022 Sep;134(17-18):636-645. doi: 10.1007/s00508-022-02040-z. Epub 2022 May 17.
Chronic kidney disease (CKD) has been associated with adverse clinical outcomes. Hyponatremia, a marker of illness severity and poor prognosis, is commonly exhibited in patients with CKD.
This cross-sectional study included patients hospitalized due to heart failure (HF). We used stepwise logistic regression to investigate the independent association of cardiovascular drugs, markers of HF severity, and baseline clinical characteristics with hyponatremia in three subgroups; normal renal function, mild-to-moderate CKD, and severe CKD.
Of the 1232 patients, 38.6% were hyponatremic. Patients with severe CKD, compared to those with normal renal function and mild-to-moderate CKD, were more likely to be hyponatremic (47.1%, 34.4% and 36.6%, respectively; p ≤ 0.0001). Alcohol consumption, female sex, n-terminal pro-brain natriuretic peptide (NT-proBNP), hydrochlorothiazide (HCT), and mineralocorticoid receptor antagonist (MRA) use, or angiotensin II receptor I blocker (ARB) non-use were associated with hyponatremia in patients with normal renal function (p ≤ 0.03 in all cases). Current smoking, diabetes mellitus, NT-proBNP, loop diuretic dose, and MRA use were predictors in mild-to-moderate CKD (p ≤ 0.04 in all cases). ARB use, loop diuretic dose, and HCT use were predictors in severe CKD (p ≤ 0.03 in all cases). Non-use of dihydropyridine calcium channel blocker (CCB) was an independent predictor of hyponatremia in all CKD stages (p ≤ 0.04 in all cases).
Apart from a firm favorable effect of CCBs, cardiovascular therapy should be carefully tailored to avoid hyponatremia in patients with cardiorenal syndrome.
慢性肾脏病（CKD）与不良临床结局相关。低钠血症是 CKD 患者疾病严重程度和预后不良的标志。
本横断面研究纳入了因心力衰竭（HF）住院的患者。我们使用逐步逻辑回归分析，在肾功能正常、轻度至中度 CKD 和重度 CKD 三组患者中，探讨心血管药物、HF 严重程度标志物和基线临床特征与低钠血症的独立相关性。
在 1232 例患者中，38.6%存在低钠血症。与肾功能正常和轻度至中度 CKD 患者相比，重度 CKD 患者更易发生低钠血症（分别为 47.1%、34.4%和 36.6%；p≤0.0001）。酒精摄入、女性、N 末端脑利钠肽前体（NT-proBNP）、氢氯噻嗪（HCT）和盐皮质激素受体拮抗剂（MRA）的使用或血管紧张素 II 受体 I 阻滞剂（ARB）的不使用与肾功能正常患者的低钠血症相关（所有情况下 p≤0.03）。当前吸烟、糖尿病、NT-proBNP、袢利尿剂剂量和 MRA 的使用是轻度至中度 CKD 的预测因素（所有情况下 p≤0.04）。ARB 的使用、袢利尿剂剂量和 HCT 的使用是重度 CKD 的预测因素（所有情况下 p≤0.03）。二氢吡啶类钙通道阻滞剂（CCB）的不使用是所有 CKD 阶段低钠血症的独立预测因素（所有情况下 p≤0.04）。
除了 CCB 有明确的有益作用外，心血管治疗应谨慎调整，以避免心脏肾综合征患者发生低钠血症。
