Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan.
The Institute of Medical Sciences, Tokai University, Isehara, Japan.
J Nephrol. 2024 Jun;37(5):1339-1349. doi: 10.1007/s40620-024-01904-z. Epub 2024 Mar 21.
Hyponatremia is implicated in pathological bone resorption and has been identified as a risk factor for bone fracture in the general population. However, there are limited data on the association between serum sodium levels and fracture risk in patients undergoing hemodialysis (HD).
We analyzed a historical cohort of 2220 maintenance HD patients to examine the association between serum sodium levels and the risk of fracture and mortality. We also examined the association between serum sodium levels and osteoporosis, based on metacarpal bone mineral density, in a subcohort of 455 patients with available data. In addition, we examined the association between serum sodium levels and bone turnover markers in a separate cross-sectional cohort of 654 maintenance HD patients.
During a median follow-up of 5.4 years, 712 patients died, 113 experienced clinical fractures, and 64 experienced asymptomatic vertebral fractures. Lower serum sodium levels were associated with an increased risk of mortality (HR 1.06 per 1 mEq/L decrease; 95% CI 1.03-1.09) but not with the risk of clinical fracture (HR 1.04 per 1 mEq/L decrease; 95% CI 0.97-1.11). A similar lack of association was observed for asymptomatic vertebral fracture and any fracture. Serum sodium levels were also not associated with osteoporosis in a subcohort with available data (n = 455) or with bone alkaline phosphatase or tartrate-resistant acid phosphatase-5b in a separate cross-sectional cohort.
Serum sodium levels were associated with mortality but not with fracture risk, osteoporosis, or bone turnover markers in maintenance HD patients.
低钠血症与病理性骨吸收有关，已被确定为普通人群发生骨折的一个危险因素。然而，关于血液透析（HD）患者血清钠水平与骨折风险之间的关系，数据有限。
我们分析了 2220 名维持性 HD 患者的历史队列，以研究血清钠水平与骨折和死亡风险之间的关系。我们还在一个有可用数据的 455 名患者亚队列中，根据掌骨骨密度检查血清钠水平与骨质疏松症之间的关系。此外，我们还在另一个 654 名维持性 HD 患者的横断面队列中检查了血清钠水平与骨转换标志物之间的关系。
在中位数为 5.4 年的随访期间，712 名患者死亡，113 名患者发生临床骨折，64 名患者发生无症状性椎体骨折。较低的血清钠水平与死亡率增加相关（每降低 1 mEq/L，HR 为 1.06；95%CI 为 1.03-1.09），但与临床骨折风险无关（每降低 1 mEq/L，HR 为 1.04；95%CI 为 0.97-1.11）。对于无症状性椎体骨折和任何骨折，也观察到类似的无关联。在一个有可用数据的亚队列（n=455）中，血清钠水平与骨质疏松症无关，在另一个独立的横断面队列中，血清钠水平与骨碱性磷酸酶或抗酒石酸酸性磷酸酶-5b 也无关。
血清钠水平与维持性 HD 患者的死亡率相关，但与骨折风险、骨质疏松症或骨转换标志物无关。
