Kidney Week

Abstract: FR-PO283

Sodium Fluctuations and Mortality in a General Hospitalized Population

Session Information

• Fluid and Electrolytes: Clinical
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid and Electrolytes

• 902 Fluid and Electrolytes: Clinical

Authors

• Lombardi, Gianmarco, Fondazione Policlinico Universitario A. Gemelli, Rome, ROME, Italy

Gianmarco Lombardi,

• Ferraro, Pietro Manuel, Fondazione Policlinico Universitario A. Gemelli, Rome, ROME, Italy

Pietro Manuel Ferraro,

• Calvaruso, Luca, Fondazione Policlinico Universitario A. Gemelli, Rome, ROME, Italy

Luca Calvaruso,

• D'Alonzo, Silvia, Fondazione Policlinico Universitario A. Gemelli, Rome, ROME, Italy

Silvia D'Alonzo,

• Naticchia, Alessandro, Fondazione Policlinico Universitario A. Gemelli, Rome, ROME, Italy

Alessandro Naticchia,

• Gambaro, Giovanni, Fondazione Policlinico Universitario A. Gemelli, Rome, ROME, Italy

Giovanni Gambaro,

Background

Aim of our study was to describe the association between natremia (Na) fluctuation and hospital mortality in a general population admitted to a tertiary medical center.

Methods

We performed a retrospective observational study on the patient population admitted to the Policlinico A. Gemelli Hospital between January 2010 and December 2014 with inclusion of adult patients with at least two Na values available on the biochemistry database and with a normonatremic condition at hospital admission.
Patients were categorized according to all Na values recorded during hospital stay in the following groups: hyponatremia, normonatremia, hypernatremia, mixed dysnatremia. The difference between the highest or lowest Na value reached during hospital stay and the Na value read at hospital admission was used to identify the maximum Na fluctuation. Cox proportional hazards models was used to estimate adjusted HRs for hospital mortality with the group of dysnatremia and with quartiles of Na fluctuation. Covariates assessed were age, sex, highest and lowest Na level, Charlson-Deyo index score, cardiovascular diseases, cerebrovascular diseases, dementia, congestive heart failure, kidney disease, eGFR.

Results

57,156 admissions matched inclusion criteria. Incident dysnatremia was independently associated with in-hospital mortality (incident hyponatremia HR 2.55, 95% CI 2.14, 3.04, p<0.001; incident hypernatremia: HR 5.71, 95% CI 4.69, 6.95, p<0.001; mix-dysnatremia: HR 4.44, 95% CI 3.23, 6.10, p<0.001). We found a higher risk of in-hospital death by linear increase of quartile of Na fluctuation (p trend <0.001) irrespective of severity of dysnatremia (HR of 1.60, CI 95% 1.17, 2.20, p=0.004, in the 4^th percentile Na fluctuation compared with the first one; Figure).

Conclusion

Fluctuation of natremia during hospital stay is a prognostic marker for hospital death independently by dysnatremia severity.