Kidney Week

Abstract: SA-PO767

Variability of Pre-Dialysis Serum Sodium and Its Association with Survival in Hemodialysis Patients: Results of the MONDO Consortium

Session Information

• Standard Hemodialysis for ESRD - I
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Ye, Xiaoling, Renal Research Institute, New York, New York, United States

Xiaoling Ye,

• Kooman, Jeroen, Maastricht University Medical Centre, Maastricht, Netherlands

Jeroen Kooman,

• Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany

Bernard J. Canaud,

• Levin, Nathan W., None, New York, New York, United States

Nathan W. Levin,

• Marelli, Cristina, Fresenius Medical Care Argentina, buenos Aires, Argentina

Cristina Marelli,

• Power, Albert J., Richard Bright Renal Unit, Bristol, United Kingdom

Albert J. Power,

• van der Sande, Frank, Maastricht University Medical Centre , Maastricht, Netherlands

Frank van der Sande,

• Thijssen, Stephan, Renal Research Institute, New York, New York, United States

Stephan Thijssen,

• Xu, Xiaoqi, Fresenius Medical Care Asia Pacific, Hong Kong, China

Xiaoqi Xu,

• Usvyat, Len A., Fresenius Medical Care North America, Melrose, Massachusetts, United States

Len A. Usvyat,

• Wang, Yuedong, University of California - Santa Barbara, Santa Barbara, California, United States

Yuedong Wang,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann,

Group or Team Name

• MONDO initiative

Background

Pre-dialysis serum sodium (SNa⁺) is the main determinant of plasma osmolality. Whereas hyponatremia is associated with adverse outcomes in hemodialysis (HD) patients (pts), variations swings in SNa⁺ may lead to fluid shifts between the extracellular and intracellular spaces and cell volume changes. The aim of the study was to explore the relationship between SNa⁺, the rate of change (slope), and the SD of the residual (variability) of SNa+ with all cause of death.

Methods

All incident and prevalent pts from the MONDO initiative with at least 6 SNa+ measurements during baseline (1^st year in HD) were selected. Follow-up defined as 2^nd year on HD. Survival analysis were applied to study the effect of SNa+, slope and variability on event. Smoothing spline logistic regression models were used to explore the joint effect of (a) SNa⁺ with variability, and (b) SNa⁺ with slope on event. Additionally, time to event analysis were used to delineate the association of various demographic and clinical parameters with event.

Results

15, 335 HD pts (63.2 years, 59% males, 24% diabetics) from Europe (10,907), West Asia (1,991), South America (283) and US (2,154) were included. Lower SNa⁺, positive and negative slope,and higher variability associated with an increased the risk of event. Increased risk of death with higher variability and slopes appeared to be present at all levels of SNa⁺, with apparently stronger effects for variability than slope (Figure 1). However, the relation between SNa+ variability and slopes with outcome lost significance after adjusted for confounders.

Conclusion

Our findings suggest that SNa⁺ variability may constitute a novel prognostic indicator. Underlying pathological conditions may explain the relation between SNa⁺ and outcome.