Abstract: PO1436
Dysnatremias and Mortality in CKD: Analysis of the Chronic Renal Insufficiency Cohort (CRIC) Study
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolyte, and Acid-Base Disorders
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Hassanein, Mohamed, Cleveland Clinic, Cleveland, Ohio, United States
- Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
- Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
- Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States
- Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
Background
Dysnatremias have been associated with increased mortality in patients with chronic kidney disease (CKD). We studied the association of dysnatremias with mortality and end-stage kidney disease (ESKD) in patients with CKD.
Methods
We included 5,444 patients from the Chronic Renal Insufficiency Cohort (CRIC) over a median time of 8.8 years. We analyzed baseline and time-dependent hyponatremia (<136 mmol/L) and hypernatremia (>145 mmol/L) with all-cause mortality and risk of ESKD using Cox proportional hazard models and competing risks models.
Results
Hyponatremia and hypernatremia were found in 9% and 1% of patients, respectively. In adjusted Cox models, time-dependent hyponatremia and hypernatremia were significantly associated with mortality (hyponatremia HR 1.37, 95% CI: 1.15, 1.63, and hypernatremia HR 1.60, 95% CI: 1.08, 2.39). Among age <65, baseline and time-dependent hyponatremia were associated with increased risk of ESKD (baseline hyponatremia HR 1.27, 95% CI: 1.008, 1.61, time-dependent hyponatremia HR 1.38, 95% CI: 1.10, 1.72). Time-dependent hypernatremia was associated with increased risk of ESKD regardless of age (HR 1.58, 95% CI: 1.02, 2.45).
Conclusion
In the CRIC, time-dependent hyponatremia and hypernatremia were significantly associated with mortality suggesting frequent measurements is predictive of prognosis. Time-dependent hypernatremia was associated with increased risk of ESKD at all ages. Baseline and time-dependent hyponatremia were associated with increased risk of ESKD in patients <65. Subjects ≥ 65 may have competing risk factors or progression of underlying comorbidities that supersede the detrimental effects of hyponatremia.
Cumulative incidence of death and ESKD across sodium groups – Graph A: Age <65, B: Age ≥ 65