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Abstract: FR-PO821

Predialysis Hyponatremia and Post-Dialysis Elevation in Serum Sodium Concentration During Hemodialysis as Significant Predictors of Mortality in Patients Undergoing Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Fujisaki, Kiichiro, Kyushu University Hospital, Fukuoka, Japan
  • Joki, Nobuhiko, TOHO University Ohashi Medical Center, Tokyo, Japan
  • Tanaka, Shigeru, Fukuoka Dental College, Fukuoka, Japan
  • Kanda, Eiichiro, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Masakane, Ikuto, Honcho-Yabuki Clinic, Yamagata, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan

Previous studies have reported that hyponatremia is associated with increased mortality in hemodialysis (HD) patients. However, there have been few reports on studying the fluctuation of serum sodium (Na) concentration during HD (ΔNa: postdialysis Na – predialysis Na) in HD patients. We conducted this cohort study using a nation-wide registry of patients with end-stage renal disease in Japan to examine the association of predialysis hyponatremia and ΔNa during HD with mortality.


We identified 178,114 patients from a nation-wide database of HD patients receiving thrice-weekly HD in Japan. The study outcome was 2-year all-cause mortality and baseline Na levels were categorized into quintiles. We examined the association of serum Na concentration and ΔNa with the mortality using a Cox proportional hazards model.


During a 2-year follow-up period, 25928 patients died from any cause. Each 1-mEq/L decrement in pre-dialysis Na concentration was associated with increased risk of all-cause death (Hazard ratio [HR], 1.05; 95% confidence interval [Cl], 1.05-1.06). In contrast, higher ΔNa level was associated with higher all-cause mortality (HR for 1 mEq/L increment in ΔNa, 1.02; 95% Cl, 1.01-1.02).
The combined association of tertiles of predialysis Na concentration and ΔNa with all-cause mortality showed the highest mortality (HR 1.09, 95% CI 1.05–1.13) in subjects with the lowest Na concentration (Na ≤136 mEq/L) and the highest ΔNa level (ΔNa >4 mEq/L) compared with those (reference) with intermediate predialysis Na concentration (137–140 mEq/L) and the lowest ΔNa level (ΔNa ≤2 mEq/L).


Lower predialysis Na concentration and higher ΔNa are associated with an increased risk of death in HD patients.