Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China.
Ren Fail. 2024 Dec;46(1):2314629. doi: 10.1080/0886022X.2024.2314629. Epub 2024 Feb 18.
Abnormal serum Na (SNa) levels are common in patients with chronic kidney disease (CKD) which is associated with increased morbidity and mortality. There are relatively few studies on the effect of SNa indicators on the prognosis of patients undergoing maintenance hemodialysis (MHD). We aim to investigate the effect of long-term SNa levels on the survival and prognosis of patients undergoing hemodialysis (HD). Newly entered HD patients in the registration system of Zhejiang Provincial Dialysis Quality Control Center between January 1, 2010 and December 31, 2019 were included and followed up until December 31, 2020. Multiple sodium levels were collected from patients, defining long-term SNa as the mean of multiple SNa, according to which patients were grouped, with the prognostic differences between subgroups compared by Kaplan-Meier modeling and multifactorial Cox regression modeling. Finally, a total of 21,701 patients were included in this study and Cox regression showed that decreased SNa levels (Na < 135 mmol/L, HR = 1.704, 95% CI 1.408-2.063, < 0.001; 135≦Na≦137.5 mmol/L, HR = 1.127,95% CI 1.016-1.250, = 0.024) and elevated SNa levels (142.5 < Na≦145mmol/L, HR = 1.198, 95% CI 1.063-1.350, = 0.003; Na > 145mmol/L, HR = 2.150, 95% CI 1.615-2.863, < 0.001) were all independent risk factors for all-cause mortality in MHD patients.
血清钠离子（SNa）水平异常在慢性肾脏病（CKD）患者中很常见，与发病率和死亡率增加有关。关于 SNa 指标对接受维持性血液透析（MHD）患者预后的影响的研究相对较少。我们旨在研究长期 SNa 水平对血液透析（HD）患者生存和预后的影响。纳入 2010 年 1 月 1 日至 2019 年 12 月 31 日浙江省透析质量控制中心登记系统中进入的新 HD 患者，并随访至 2020 年 12 月 31 日。根据患者的多次 SNa 值，定义长期 SNa 为多次 SNa 的平均值，并根据 SNa 平均值对患者进行分组，通过 Kaplan-Meier 模型和多因素 Cox 回归模型比较亚组之间的预后差异。最终，共纳入 21701 例患者，Cox 回归显示 SNa 水平降低（Na < 135mmol/L，HR = 1.704，95%CI 1.408-2.063， < 0.001；135≦Na≦137.5mmol/L，HR = 1.127，95%CI 1.016-1.250， = 0.024）和 SNa 水平升高（142.5 < Na≦145mmol/L，HR = 1.198，95%CI 1.063-1.350， = 0.003；Na > 145mmol/L，HR = 2.150，95%CI 1.615-2.863， < 0.001）均是 MHD 患者全因死亡率的独立危险因素。
