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Hyponatremia as a predictor of mortality in peritoneal dialysis patients

 Tae Ik Chang  ;  Yung Ly Kim  ;  Hyungwoo Kim  ;  Geun Woo Ryu  ;  Ea Wha Kang  ;  Jung Tak Park  ;  Tae-Hyun Yoo  ;  Sug Kyun Shin  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Dae Suk Han  ;  Seung Hyeok Han 
 PLOS ONE, Vol.9(10) : e111373, 2014 
Journal Title
Issue Date
Adult ; Aged ; Female ; Humans ; Hyponatremia/diagnosis* ; Hyponatremia/etiology ; Male ; Middle Aged ; Peritoneal Dialysis/adverse effects* ; Peritoneal Dialysis/mortality ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy
BACKGROUND AND AIM: Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients. METHODS: This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients. RESULTS: Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = -0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73-0.86; p<0.001) and infection-related (HR per 1 mEq/L increase, 0.77; 95% CI, 0.70-0.85; p<0.001) deaths. CONCLUSIONS: This study showed that hyponatremia is an independent predictor of mortality in PD patients. Nevertheless, whether correcting hyponatremia improves patient survival is unknown. Future interventional studies should address this question more appropriately.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kang, Ea Wha(강이화)
Kim, Yung Ly(김영리)
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Ryu, Geun Woo(류근우)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Shin, Sug Kyun(신석균)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Chang, Tae Ik(장태익)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Dae Suk(한대석)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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