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Abstract: FR-PO205

Association Between Changes in Pre-Transition Sodium with Post-Transition Mortality and Hospitalization Among Patients Transitioning to Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Marroquin, Maria V., Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Kleine, Carola-Ellen, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Soohoo, Melissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
Background

Disturbances in the serum sodium metabolism are common in advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD). Additionally, CKD patients transitioning to dialysis-dependent ESRD have a particularly high mortality risk within the first month of transition. Thus, we examined the relationship between pre-ESRD change in sodium and post-ESRD outcomes.

Methods

We retrospectively examined a cohort of 22,644 veterans transitioning to ESRD between 2007-2015. Patients were grouped into three categories according to their change in sodium. Changes in sodium from 6 to 3 months prior to ESRD transition were calculated by using a mixed-effects model. We explored the association between change in sodium levels, with post-ESRD transition overall all-cause mortality using Cox proportional hazard models, and hospitalization incident rate ratio (HIRR) with Poisson regression. Associations were examined across multiple levels of adjustments including case-mix variables, markers of malnutrition and inflammation, glucose and medications.

Results

Mean age of the total cohort was 67±11 years and median change in sodium level was 0.4 (-1.1,2.0) mEq/L. Both, increasing and decreasing sodium levels were associated with a higher all-cause mortality risk in the fully adjusted model (HR 1.10, 95%CI 1.05-1.15) [figure 1A]. A similar pattern was observed for HIRR across hierarchical adjustments; however the association was attenuated for increasing sodium levels in the fully adjusted model (HR 1.06 95%CI 1.01-1.10) [figure 1B].

Conclusion

Changes in pre-ESRD serum sodium are associated with post-transition death risk and HIRR. Monitoring pre-transition sodium levels may help identify patients at risk for adverse outcomes after ESRD transition.

Funding

  • NIDDK Support