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Abstract: TH-PO013

Hyponatremia and AKI in Critically Ill Children

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Formeck, Cassandra Lynn, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States
  • Joyce, Emily Lauren, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States
  • Priyanka, Priyanka, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Badavanahalli Rajashekar, Shashank, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Ayus, Juan Carlos, Renal Consultants of Houston, Houston, Texas, United States
  • Kellum, John A., The University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Moritz, Michael L., Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States
Background

Hyponatremia is associated with increased morbidity and mortality in hospitalized patients for unknown reasons. Hyponatremia is also associated with osmotic cellular stress. Renal tubular epithelial are exposed to numerous stressors in critically ill patients. We hypothesized that hyponatremia would be associated with a greater rate of acute kidney injury (AKI) in critically ill children. Our objective was to evaluate the association between hyponatremia and AKI, controlling for sepsis, a primary coexposure.

Methods

Using a pediatric ICU database of 12,806 admissions, we included patients with a measured sodium value within 6 hours of ICU admission, and excluded patients with AKI or significant chronic renal dysfunction. We analyzed the association between hyponatremia (serum Na < 135 mEq/L), sepsis and known nephrotoxic drug exposure within 48 hours of ICU admission, on the development of stage 2 or 3 AKI within 7 days. For the primary analysis, we stratified by the presence or absence of sepsis at ICU admission, and compared rates of AKI in patients with and without expsoure to hyponatremia or 3 or more nephrotoxic medications.

Results

A total of 5,300 patients (male 58%; mean age 7.5 years) were included in the analysis. 16.1% of patients had hyponatremia, 7.0% nephrotoxic medication exposure and 30.1% developed sepsis. The incidence of stage 2 or 3 AKI was 8.8% in hyponatremic patients with sepsis compared to 14.7% in hyponatremic patients without sepsis. Patients with hyponatremia and nephrotoxic medication exposure were at increased risk for AKI in the absence of sepsis (p <0.001, p 0.008). Patients with hyponatremia, with and without sepsis, were more likely to develop AKI compared to patients with normonatremia (RR 1.11, RR 1.82). In children without sepsis, patients with hyponatremia were at higher risk of developing AKI than patients with exposure to 3 or more nephrotoxic medications (RR 1.82, RR 1.57).

Conclusion

Hyponatremia is a significant risk factor for AKI in critically in children in the absence of sepsis.

Funding

  • NIDDK Support