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Abstract: TH-OR072

Impact of Fluid Status, Serum Sodium, and Their Interaction on Survival: A Study in an Interactional Hemodialysis Patient Cohort

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Ye, Xiaoling, Renal Research Institute , New York, New York, United States
  • Garbelli, Mario, Fresenius Medical Care Italia, Vaiano Cremasco, Italy
  • Kooman, Jeroen, Maastricht University Medical Centre, Maastricht, Netherlands
  • Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany
  • Kotanko, Peter, Renal Research Institute , New York, New York, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Stuard, Stefano, Fresenius Medical Care, Waltham, Massachusetts, United States

While hyponatremia and fluid overload (FO) are associated with mortality in hemodialysis (HD) patients (pts), little is known about their interaction. We aimed to investigate whether the relation between serum sodium (SNa) and mortality differs in HD pts with different fluid status (FS) assessed by whole-body bioimpedance spectroscopy.


We included all incident in-center adult HD pts treated 01/2010 to 12/2018 in Fresenius Medical Care clinics in 18 European countries and with ≥1 pre-HD SNa and body composition measurements within the first 3 months on HD. We excluded pts with ≥1 SNa value outside 125 to 150 mmol/L. Baseline was defined as the first year on HD, follow-up comprised years 2 and 3. We averaged laboratory and clinical parameters during baseline. A smoothing spline analysis of variance Cox proportional hazard model was applied to explore the joint effects of SNa and FS on mortality (adjusted for age, gender, ultrafiltration rate(UFR), diabetes(DM), and CHF).


Out of the 5938 pts, 4407(74%) were normovolemic, and 1531(26%) had FO. Compared with pts with normovolemic status, FO pts had lower SNa levels, higher Na gradient, higher UFR and DM prevalence (Table1). For normovolemic pts, higher SNa levels (≥138 mmol/L) were associated with better survival. Mortality risk was highest for pts with FO, independent of SNa (Figure1).


The relation between SNa and mortality is dependent on pre-HD FS. Whereas low SNa appears to be disadvantageous in normovolemia and FO pts, the relative effect of FO on outcome appears to be stronger than the effect of low SNa per se. In normovolemic pts the relation between SNa and outcome should be interpreted in the context of FS and not as an isolated risk marker.