ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: SA-PO736

Chronic Hyponatremia Is Independently Associated with Mortality at Each Stage of CKD

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Achinger, Steven, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
  • Kumar, Ambuj, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
  • Tsalatsanis, Athanasios, University of South Florida Morsani College of Medicine, Tampa, Florida, United States

Prior studies have shown hyponatremia is associated with mortality among patients with CKD. What is not clear is whether or not hyponatremia is a marker of underlying disease severity or if hyponatremia is associated with mortality independent of the severity of the underlying CKD and other comorbid conditions. The objective of this study is to determine if chronic hyponatremia (> 90 days duration) is independently associated with mortality and secondary outcomes at all stages of CKD.


All adult patients with CKD with chronic hyponatremia (cases) and without chronic hyponatremia (controls) between 2012 and 2018 were eligible for inclusion. The groups were matched for demographics and CKD stage using propensity scores. TriNetX research network was used to identify cohorts. The follow-up time was 5 years after CKD diagnosis. Primary outcome was mortality. Secondary outcomes were cerebrovascular, cardiovascular, infectious, thrombotic and neurodegenerative outcomes. All outcomes were analyzed as time to event using Kaplan-Meier analysis and summarized as hazard ratios. Subgroup analysis was performed for each CKD stage.


The analysis included 25,944 cases and 25,944 matched controls. The mean age for cases was 66.3 (SD 15.8) and 65.9 (SD 16) years in controls. Patients in the cases group had higher chances of death (HR: 2.11, 95% CI: 2.05-2.18, p<0.001), stroke (HR: 1.92, 95% CI: 1.82-2.02, p<0.001), sepsis (HR: 4.17, 95% CI: 3.99-4.36, p<0.001), ischemic heart disease (HR: 1.7, 95% CI: 1.65-1.74, p<0.001), myocardial infarction (HR: 2.42, 95% CI: 2.31-2.54, p<0.001), CHF (HR: 2.32, 95% CI: 2.24-2.41, p<0.001), pneumonia (HR: 2.29, 95% CI: 2.20-2.37, p<0.001), cellulitis (HR: 2.06, 95% CI: 1.92-2.14, p<0.001), PE (HR: 2.09, 95% CI: 1.92-2.27, p<0.001) and dementia (HR: 1.66, 95% CI: 1.56-1.76, p=0.005). Subgroup analyses indicated consistent trends in each CKD stage.


At each of stages of CKD, 1 and 2 collectively, 3, 4 and 5, chronic hyponatremia is independently associated with morbidity and mortality.