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Hyponatremia Predicts New-Onset Cardiovascular Events in Peritoneal Dialysis Patients

Authors
 Hyung Woo Kim  ;  Geun Woo Ryu  ;  Cheol Ho Park  ;  Ea Wha Kang  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Sug Kyun Shin  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Dae Suk Han  ;  Tae Ik Chang 
Citation
 PLOS ONE, Vol.10(6) : e0129480, 2015 
Journal Title
 PLOS ONE 
Issue Date
2015
MeSH
Cardiovascular Diseases/etiology* ; Humans ; Hyponatremia/complications* ; Incidence ; Multivariate Analysis ; Peritoneal Dialysis* ; Proportional Hazards Models ; Risk Factors
Abstract
BACKGROUND AND AIM: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients on peritoneal dialysis (PD). Hyponatremia was recently shown to be a modifiable factor that is strongly associated with increased mortality in PD patients. However, the clinical impact of hyponatremia on CV outcomes in these patients is unclear. METHODS: To determine whether a low serum sodium level predicts the development of CV disease, we carried out a prospective observational study of 441 incident patients who started PD between January 2000 and December 2005. Time-averaged serum sodium (TA-Na) levels were determined to investigate the ability of hyponatremia to predict newly developed CV events in these patients. RESULTS: During a mean follow-up of 43.2 months, 106 (24.0%) patients developed new CV events. The cumulative incidence of new-onset CV events after the initiation of PD was significantly higher in patients with TA-Na levels ≤ 138 mEq/L than in those with a TA-Na > 138 mEq/L. After adjustment for multiple potentially confounding covariates, an increase in TA-Na level was found to be associated with a significantly lower risk of CV events (subdistribution hazard ratio per 1 mEq/L increase, 0.90; 95% confidence interval, 0.83-0.96; p = 0.003). Patients with a TA-Na ≤ 138 mEq/L had a 2.31-fold higher risk of suffering a CV event. CONCLUSIONS: These results provide evidence of a clear association between low serum sodium and new-onset CV events after dialysis initiation in PD patients. Whether the correction of hyponatremia for this indication provides additional protection for the development of CV disease in these patients remains to be addressed in interventional studies.
Files in This Item:
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DOI
10.1371/journal.pone.0129480
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Park, Cheol Ho(박철호) ORCID logo https://orcid.org/0000-0003-4636-5745
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/166902
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