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, TaeHyun Yoo, Sug Kyun Shin, Shin-Wook Kang, Kyu Hun Choi, Dae Suk Han, SeungHyeok Han

Research output: Contribution to journalArticle

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Abstract

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 =20.114; 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.

Original languageEnglish
Article numbere111373
JournalPloS one
Volume9
Issue number10
DOIs
Publication statusPublished - 2014 Oct 29

Fingerprint

hyponatremia
Dialysis
Hyponatremia
Peritoneal Dialysis
dialysis
Mortality
Sodium
Ultrafiltration
Linear regression
Regression analysis
Serum Albumin
death
sodium
hemodialysis
risk reduction
observational studies
serum albumin
renal function
ultrafiltration
kidney diseases

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Chang, T. I., Kim, Y. L., Kim, H., Ryu, G. W., Kang, E. W., Park, J. T., ... Han, S. (2014). Hyponatremia as a predictor of mortality in peritoneal dialysis patients. PloS one, 9(10), [e111373]. https://doi.org/10.1371/journal.pone.0111373
Chang, Tae Ik ; Kim, Yung Ly ; Kim, Hyungwoo ; Ryu, Geun Woo ; Kang, Ea Wha ; Park, Jung Tak ; Yoo, TaeHyun ; Shin, Sug Kyun ; Kang, Shin-Wook ; Choi, Kyu Hun ; Han, Dae Suk ; Han, SeungHyeok. / Hyponatremia as a predictor of mortality in peritoneal dialysis patients. In: PloS one. 2014 ; Vol. 9, No. 10.
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abstract = "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 =20.114; 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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Chang, TI, Kim, YL, Kim, H, Ryu, GW, Kang, EW, Park, JT, Yoo, T, Shin, SK, Kang, S-W, Choi, KH, Han, DS & Han, S 2014, 'Hyponatremia as a predictor of mortality in peritoneal dialysis patients', PloS one, vol. 9, no. 10, e111373. https://doi.org/10.1371/journal.pone.0111373

Hyponatremia as a predictor of mortality in peritoneal dialysis patients. / Chang, Tae Ik; Kim, Yung Ly; Kim, Hyungwoo; Ryu, Geun Woo; Kang, Ea Wha; Park, Jung Tak; Yoo, TaeHyun; Shin, Sug Kyun; Kang, Shin-Wook; Choi, Kyu Hun; Han, Dae Suk; Han, SeungHyeok.

In: PloS one, Vol. 9, No. 10, e111373, 29.10.2014.

Research output: Contribution to journalArticle

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T1 - Hyponatremia as a predictor of mortality in peritoneal dialysis patients

AU - Chang, Tae Ik

AU - Kim, Yung Ly

AU - Kim, Hyungwoo

AU - Ryu, Geun Woo

AU - Kang, Ea Wha

AU - Park, Jung Tak

AU - Yoo, TaeHyun

AU - Shin, Sug Kyun

AU - Kang, Shin-Wook

AU - Choi, Kyu Hun

AU - Han, Dae Suk

AU - Han, SeungHyeok

PY - 2014/10/29

Y1 - 2014/10/29

N2 - 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 =20.114; 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.

AB - 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 =20.114; 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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Chang TI, Kim YL, Kim H, Ryu GW, Kang EW, Park JT et al. Hyponatremia as a predictor of mortality in peritoneal dialysis patients. PloS one. 2014 Oct 29;9(10). e111373. https://doi.org/10.1371/journal.pone.0111373