Abstract: SA-PO1005
Impact of the Serum Sodium and Chloride Difference on All-Cause Mortality in Japanese Hemodialysis Patients: The Miyazaki Dialysis Cohort Study
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Toida, Tatsunori, University of Miyazaki, Miyazaki, Miyazaki, Japan
- Sato, Yuji, University of Miyazaki Hospital, Miyazaki, Miyazaki, Japan
- Kitamura, Kazuo, Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Fujimoto, Shouichi, University of Miyazaki, Miyazaki, Miyazaki, Japan
Background
Few studies have examined the relationship between the acid-base balance and mortality in hemodialysis patients. In actual clinical settings, the regular collection of blood gas data is rarely conducted. In theory, the serum sodium and chloride difference (SCD) is equal to the anion gap plus bicarbonate, and we herein investigated whether SCD as a simple acid-base balance index affected the risk of mortality in maintenance hemodialysis patients.
Methods
Study design: Cohort study.
Setting, Participants: Data from the Miyazaki Dialysis Cohort study, including 1113 hemodialysis patients aged ≥18 years, dialysate sodium 140 mEq/L, with SCD pre- and post-dialysis.
Predictors: Pre-dialysis SCD, <33, 33 to 35, 35 to 37, ≥37 (reference), and post-dialysis SCD <36, 36 to 37, 37 to 39, ≥39 (reference) according to quartiles.
Outcomes: All-cause mortality during a 2-year follow-up.
Measurements: The crude mortality rate in each group was assessed using a Kaplan–Meier analysis with the Log-rank test. Hazard ratios (HRs) were estimated using Cox’s model for the relationships between SCD categories and mortality, and adjusted for potential confounders. Patients in the higher group were set as our reference category.
Results
Among the 1113 patients in this cohort study (median age [interquartile range], age 69 [59-77] years, dialysis vintage 72 [34-141] months, and females 42.7%), 154 patients died during the follow-up. The Kaplan-Meier analysis showed that the survival rate was significantly lower in patients in the lowest SCD (<36) group post-dialysis than in those in the other groups (Log-rank test, P<0.01), whereas no significant differences were observed pre-dialysis (Log-rank test, P=0.26). Cox’s regression analysis showed that the lowest SCD (<36) group post-dialysis was independently associated with an increased risk of mortality (adjusted HR [95% CI] 2.01 [1.25-3.23]). No relationship was observed between pre-dialysis SCD levels and all-cause mortality.
Conclusion
Among Japanese maintenance hemodialysis patients, low SCD levels post-dialysis, but not pre-dialysis, increased the risk of mortality. The present results suggest that SCD post-dialysis is a predictor of mortality.