Hyponatremia predicts new-onset cardiovascular events in peritoneal dialysis patients

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

Research output: Contribution to journalArticle

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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 newonset 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.

Original languageEnglish
Article numbere0129480
JournalPloS one
Volume10
Issue number6
DOIs
Publication statusPublished - 2015 Jun 8

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hyponatremia
Dialysis
Hyponatremia
Peritoneal Dialysis
dialysis
Sodium
cardiovascular diseases
Cardiovascular Diseases
sodium
Serum
Hazards
Mortality
observational studies
Observational Studies
morbidity
confidence interval
Prospective Studies
Confidence Intervals

All Science Journal Classification (ASJC) codes

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

Cite this

Kim, H. W., Ryu, G. W., Park, C. H., Kang, E. W., Park, J. T., Han, S. H., ... Chang, T. I. (2015). Hyponatremia predicts new-onset cardiovascular events in peritoneal dialysis patients. PloS one, 10(6), [e0129480]. https://doi.org/10.1371/journal.pone.0129480
Kim, Hyung Woo ; Ryu, Geun Woo ; Park, Cheol Ho ; Kang, Ea Wha ; Park, Jung Tak ; Han, Seung Hyeok ; Yoo, Tae Hyun ; Shin, Sug Kyun ; Kang, Shin Wook ; Choi, Kyu Hun ; Han, Dae Suk ; Chang, Tae Ik. / Hyponatremia predicts new-onset cardiovascular events in peritoneal dialysis patients. In: PloS one. 2015 ; Vol. 10, No. 6.
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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 newonset 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.",
author = "Kim, {Hyung Woo} and Ryu, {Geun Woo} and Park, {Cheol Ho} and Kang, {Ea Wha} and Park, {Jung Tak} and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Shin, {Sug Kyun} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Han, {Dae Suk} and Chang, {Tae Ik}",
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Kim, HW, Ryu, GW, Park, CH, Kang, EW, Park, JT, Han, SH, Yoo, TH, Shin, SK, Kang, SW, Choi, KH, Han, DS & Chang, TI 2015, 'Hyponatremia predicts new-onset cardiovascular events in peritoneal dialysis patients', PloS one, vol. 10, no. 6, e0129480. https://doi.org/10.1371/journal.pone.0129480

Hyponatremia predicts new-onset cardiovascular events in peritoneal dialysis patients. / Kim, Hyung Woo; Ryu, Geun Woo; Park, Cheol Ho; Kang, Ea Wha; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae Hyun; Shin, Sug Kyun; Kang, Shin Wook; Choi, Kyu Hun; Han, Dae Suk; Chang, Tae Ik.

In: PloS one, Vol. 10, No. 6, e0129480, 08.06.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hyponatremia predicts new-onset cardiovascular events in peritoneal dialysis patients

AU - Kim, Hyung Woo

AU - Ryu, Geun Woo

AU - Park, Cheol Ho

AU - Kang, Ea Wha

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Shin, Sug Kyun

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Han, Dae Suk

AU - Chang, Tae Ik

PY - 2015/6/8

Y1 - 2015/6/8

N2 - 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 newonset 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.

AB - 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 newonset 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.

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