The impact of low serum sodium level on mortality depends on glycemic control
Küçük Resim Yok
Tarih
2012
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Background Low serum sodium levels have been associated with mortality both in patients with and without chronic kidney disease. In this study, we investigated this association in relation to glycemic control in hemodialysis (HD) patients. Materials and methods Between March and September 2005, 697 prevalent HD patients were enrolled in this prospective observational study and followed up for all-cause and cardiovascular mortality. The associations of serum sodium concentration with both overall and cardiovascular survival rates were studied. Results At baseline, mean predialysis serum sodium concentration was 138·4±2·3mEq/L (range: 130-145mEq/L). Mild hyponatremia (<135mEq/L) was present in only 41 subjects (5·9%), and no patient had serum sodium level <130mEq/L. During 20·2±6·2months of follow-up, 119 patients (15·9%) died, 68 from CV causes. In adjusted Cox regression analysis, lowest sodium quartile was associated with 2·13-fold increased risk of overall mortality (95% confidence interval (CI) 1·14-3·98, P=0·01, model chi-square 114·6, P<0·001). As a continuous variable, each 1mEq/L increase in predialysis sodium concentration was associated with a hazard ratio (HR) of 0·87 for overall mortality (95% CI 0·81-0·95, P=0·002) and 0·86 for cardiovascular mortality (95% CI 0·78-0·96, P=0·007). The predictivity of low serum sodium was prominent in diabetic subjects but not in nondiabetics. However, relationship between serum sodium and patient survival in diabetics was lost after adjustment for the HbA1c level: HR 0·91 (95% CI 0·78-1·05, P=0·20). Conclusions Low serum sodium concentration is associated with mortality only in those with diabetes. Furthermore, the impact of serum sodium on survival in these patients seems to be derived from poor glucose control. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.
Açıklama
Anahtar Kelimeler
Glycemic control, HbA1c, Hemodialysis, Mortality, Serum sodium
Kaynak
European Journal of Clinical Investigation
WoS Q Değeri
Scopus Q Değeri
Q1
Cilt
42
Sayı
5
