Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort
- Authors
- Han, Sang-Woong; Tilea, Anca; Gillespie, Brenda W.; Finkelstein, Fredric O.; Kiser, Margaret A.; Eisele, George; Kotanko, Peter; Levin, Nathan; Saran, Rajiv
- Issue Date
- May-2015
- Publisher
- KARGER
- Keywords
- Epidemiology; Hypernatremia; Hyponatremia; Mortality; Progression; Sodium
- Citation
- AMERICAN JOURNAL OF NEPHROLOGY, v.41, no.3, pp.200 - 209
- Indexed
- SCIE
SCOPUS
- Journal Title
- AMERICAN JOURNAL OF NEPHROLOGY
- Volume
- 41
- Number
- 3
- Start Page
- 200
- End Page
- 209
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/157359
- DOI
- 10.1159/000381193
- ISSN
- 0250-8095
- Abstract
- Background: Chronic kidney disease (CKD) patients are prone to both hypo- and hypernatremia. Little has been published on the epidemiology of hypo- and hypernatremia in ambulatory patients with non-dialysis CKD. Methods: Data collected in two contemporaneous CKD cohort studies, the Renal Research Institute (RRI)-CKD study (n = 834) and the Study of Treatment of Renal Insufficiency: Data and Evaluation (STRIDE) (n = 1,348) were combined and analyzed to study the association between serum sodium (Na+) and clinical outcomes. Results: Baseline estimated glomerular filtration rate (eGFR) and Na+ were 26 +/- 11 ml/min/1.73 m(2) and 140.2 +/- 3.4 mEq/l, respectively. The prevalence of Na+ <= 135 mEq/l and >= 144 mEq/l was 6 and 16%, respectively. Higher baseline Na+ was significantly associated with male sex, older age, systolic blood pressure, BMI, serum albumin, presence of heart failure, and lower eGFR. The risk of end-stage renal disease (ESRD) was marginally significantly higher among patients with Na+ <= 135 mEq/l, compared with 140< Na+ <144 mEq/l (referent), in time-dependent models (adjusted hazard ratio, HR = 1.52, p = 0.06). Mortality risk was significantly greater at 135< Na+ <= 140 mEq/l (adjusted HR = 1.68, p = 0.02) and Na+ >= 144 mEq/l (adjusted HR = 2.01, p = 0.01). Conclusion: CKD patients with Na+ <= 135 mEq/l were at a higher risk for progression to ESRD, whereas both lower and higher Na+ levels were associated with a higher risk of mortality. While caring for CKD patients, greater attention to serum sodium levels by clinicians is warranted and could potentially help improve patient outcomes.
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