Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan.
Clin Exp Nephrol. 2023 Sep;27(9):747-756. doi: 10.1007/s10157-023-02363-9. Epub 2023 Jun 2.
Hyponatremia is a common electrolyte disorder in patients with chronic kidney disease. In addition, hyponatremia is associated with mortality in patients with chronic kidney disease, including those on dialysis. However, few studies have examined this relationship in patients with incident dialysis.
We used a database of multicenter prospective cohort studies that included 1520 incident dialysis patients. The baseline was set at the time of dialysis initiation. The enrolled patients were classified into five groups according to their serum sodium levels (< 130 mEq/L, 130-134 mEq/L, 135-139 mEq/L, 140-144 mEq/L, and ≥ 145 mEq/L). Multivariate Cox proportional hazards analysis was conducted to determine factors associated with all-cause mortality.
A total of 392 all-cause deaths occurred during the follow-up period. The ultrafiltration volume per body weight during the first dialysis session was more significant in the groups with the lowest and highest sodium levels. The percentage of patients using loop diuretics and thiazide was higher in the group with lower sodium levels (< 130 mEq/L and 130-134 mEq/L). All-cause mortality was significantly different among the five groups (p = 0.025). Multivariate analysis indicated that all-cause mortality was significantly higher in the group with the lowest sodium level compared to the group with a serum sodium level of 135-139 mEq/L (hazard ratio: 1.61, 95% confidence interval: 1.04-2.49).
Hyponatremia of < 130 mEq/L at dialysis initiation was significantly associated with all-cause mortality. We considered the results relevant to underlying conditions, including cardiovascular disease and medications.
低钠血症是慢性肾脏病患者中常见的电解质紊乱。此外，低钠血症与慢性肾脏病患者的死亡率相关，包括透析患者。然而，很少有研究检查过这种关系在新开始透析的患者中。
我们使用了一个多中心前瞻性队列研究的数据库，其中包括 1520 名新开始透析的患者。基线设定在开始透析时。根据血清钠水平，将纳入的患者分为五组(<130 mEq/L、130-134 mEq/L、135-139 mEq/L、140-144 mEq/L 和 ≥145 mEq/L)。采用多变量 Cox 比例风险分析确定与全因死亡率相关的因素。
在随访期间，共发生 392 例全因死亡。首次透析期间的每公斤体重超滤量在钠水平最低和最高的组中更为显著。低钠组(<130 mEq/L 和 130-134 mEq/L)使用袢利尿剂和噻嗪类利尿剂的患者比例较高。五组间全因死亡率差异有统计学意义(p=0.025)。多变量分析表明，与血清钠水平为 135-139 mEq/L 的组相比，钠水平最低的组全因死亡率显著更高(危险比：1.61，95%置信区间：1.04-2.49)。
透析开始时的低钠血症 <130 mEq/L 与全因死亡率显著相关。我们认为这些结果与包括心血管疾病和药物在内的潜在疾病有关。
