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Mortality Associated with Low Serum Sodium Concentration in Maintenance Hemodialysis
The American journal of medicine, 2011, Vol.124 (1), p.77-84
Waikar, Sushrut S., MD, MPH
Curhan, Gary C., MD, ScD
Brunelli, Steven M., MD, MSCE
2011
Volltextzugriff (PDF)
Details
Autor(en) / Beteiligte
Waikar, Sushrut S., MD, MPH
Curhan, Gary C., MD, ScD
Brunelli, Steven M., MD, MSCE
Titel
Mortality Associated with Low Serum Sodium Concentration in Maintenance Hemodialysis
Ist Teil von
The American journal of medicine, 2011, Vol.124 (1), p.77-84
Ort / Verlag
New York, NY: Elsevier Inc
Erscheinungsjahr
2011
Quelle
MEDLINE
Beschreibungen/Notizen
Abstract Background Low serum sodium concentrations are associated with an increased risk of death in the general population, but causality is uncertain due to confounding from clinical conditions such as congestive heart failure and cirrhosis, in which hyponatremia results from elevated levels of arginine vasopressin. Methods To examine the association between predialysis serum sodium concentration and mortality in patients undergoing hemodialysis for end-stage renal disease, a condition in which arginine vasopressin does not affect water excretion and osmoregulation, we studied 1549 oligoanuric participants in the HEMO study, a randomized controlled trial of hemodialysis patients examining the effect of hemodialysis dose and flux. We used proportional hazards models to compare the risk of death according to predialysis serum sodium concentration. Results Considered as a continuous variable, each 4-mEq/L increment in baseline predialysis serum sodium concentration was associated with a hazard ratio for all-cause mortality of 0.84 (95% confidence interval (CI), 0.78-0.90). Multivariable adjustment for demographic, clinical, laboratory, and dialysis-specific covariates, including ultrafiltration volume, did not appreciably change the results (hazard ratio for all-cause mortality of 0.89; 95% CI, 0.82-0.96). The results also were consistent in time-updated analyses using repeated measures of serum sodium and other relevant covariates. Conclusion Lower predialysis serum sodium concentration is associated with an increased risk of death. Considering the unique physiology in the dialysis population, these findings raise the possibility that hyponatremia itself may be a causal determinant of mortality in the broader population. © 2011 Elsevier Inc. All rights reserved.
Sprache
Englisch
Identifikatoren
ISSN: 0002-9343
eISSN: 1555-7162
DOI: 10.1016/j.amjmed.2010.07.029
Titel-ID: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3040578
Format
–
Schlagworte
Adult
,
Aged
,
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
,
Biological and medical sciences
,
Cardiovascular Diseases - mortality
,
Cause of Death
,
Clinical trials
,
Emergency and intensive care: renal failure. Dialysis management
,
End-stage renal disease
,
Epidemiology
,
Female
,
General aspects
,
Hemodialysis
,
Humans
,
Hyponatremia
,
Hyponatremia - mortality
,
Intensive care medicine
,
Internal Medicine
,
Kidney diseases
,
Male
,
Medical sciences
,
Middle Aged
,
Mortality
,
Public health. Hygiene
,
Public health. Hygiene-occupational medicine
,
Renal Dialysis - mortality
,
Risk factors
,
Sodium - blood
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