Abstract: FR-PO295
Hyponatremia and Renal Dysfunction in Acute Heart Failure
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
- Yamada, Masaaki, University of Cincinnati, Cincinnati, Ohio, United States
- Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
- Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
- Amlal, Hassane, University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background
Acute heart failure (HF) is a common cause of hospitalization and risk factor for hyponatremia (hypoNa) as well as renal dysfunction. Although renal function influences both HF and sodium (Na) regulation, this interrelationship is not studied in acute care settings. Moreover, effect of Na correction in HF during acute care is not known.
Methods
We examined all adults, >18 years of age, requiring 24 or more hours of hospitalization for HF from a national multicenter sample derived from Cerner Health Facts between 1/2010 and 6/2016. Admission Na levels in mEq/L were classified as severe hypoNa (<130), moderate hypoNa (130-134), mild hypoNa (135-139), normal (140-144), or hypernatremia (>145). By logistic regression adjusted for major confounders, with normal as a reference group, risk of all cause hospital mortality/hospice (primary outcome) or 30-day readmission was modeled for other Na groups. We further assessed effect of correction of Na at discharge relative to admission on the primary outcome as well.
Results
Sample included 109,906 HF patients with median age of 74 years (Q1, Q3, 63, 84); 49% female; 19% Black; median serum Cr 1.2 mg/dL (Q1, Q3, 0.9, 1.7). Na classes were 5% (<130), 13% (130-134), 41% (135-139), 36% (140-144), and 5% (≥145). Overall hospital mortality was 5%; crude mortality rate showed a “U”-shaped relationship by Na classes (p <0.001). Compared to the normal class, adjusted odds ratio (aOR); 95% confidence interval (CI) were 2.3 (2.1-2.6) in Na <130; 1.7 (1.6-1.9) in Na 130-134; 1.2 (1.1-1.3) in Na 135-139; and 1.8 (1.6-2.0) in Na ≥145. Renal dysfunction defined as Cr ≥1.3 mg/dL on admission was associated with increased mortality independent of Na (aOR 1.6; 95% CI, 1.5-1.7) compared to others. Among the 5,130 severe hypoNa patients, compared to those who corrected from <130 to 130-139, the risk of mortality in patients who remained <130; corrected to normal (140-144); or over corrected (≥145) was aOR 2.1 (95% CI, 1.7-2.6), 2.5 (95% CI, 1.7-3.5), and 10.5 (95% CI, 6.0-18.5) respectively. Overall, 30-day readmission rate was 15%; compared to normal group (14%) it was higher in severe hypoNa (18%, p <0.001) and aOR 1.4 (95% CI, 1.3-1.5).
Conclusion
Management of hypoNa, in concert with level of renal function, is necessary to improve key HF outcomes. However, correcting severe hypoNa to normal or above normal may be harmful in acute HF.
Funding
- Commercial Support – Otsuka