Korean J Intern Med.  2018 Sep;33(5):970-979. 10.3904/kjim.2016.296.

Predialysis hyponatremia and mortality in elderly patients beginning to undergo hemodialysis

• Baek SH
• Kim S
• Na KY
• Kim S
• Chin HJ

• KMID: 2420009
• DOI: http://doi.org/10.3904/kjim.2016.296

Abstract

BACKGROUND/AIMS
Predialysis hyponatremia has been recently reported to be associated with mortality in incident hemodialysis patients. However, whether hyponatremia is associated with unfavorable outcomes in elderly patients remains unknown. We hypothesized that nephrology referral inf luences hyponatremia, and aimed to define how nephrology referral affects the association between hyponatremia and mortality in the elderly.
METHODS
We retrospectively assessed mortality in 599 incident hemodialysis patients aged ≥ 70 at a tertiary university hospital, between 2000 and 2010. We analyzed 90-day and 1-year all-cause mortality (ACM) in relation to predialysis serum sodium (sNa). We divided the patients into two groups according to predialysis glucose-corrected sNa: hyponatremia (< 135 mmol/L) and normonatremia (135 to 145 mmol/L).
RESULTS
Low estimated glomerular filtration rate, high phosphorus, low albumin, nonpreparation of arteriovenous fistula or graft, and late referral were associated with a low sNa in the elderly. Among 599 patients, 106 and 174 patients died at the 90-day and 1-year follow-ups, respectively. Each 10-mmol/L increase in predialysis sNa tended to be associated with lower 90-day and 1-year ACM. When patients were stratified by nephrology referral, hyponatremia was associated with increased mortality in early referral group (90-day ACM: hazard ratio [HR] = 2.335, p = 0.041; 1-year ACM: HR = 1.790, p = 0.024). However, hyponatremia was not associated with mortality in late referral group.
CONCLUSIONS
Predialysis hyponatremia at hemodialysis initiation is associated with late referra

Keyword

Hyponatremia; Mortality; Hemodialysis; Nephrology referral

MeSH Terms

Aged*
Arteriovenous Fistula
Follow-Up Studies
Glomerular Filtration Rate
Humans
Hyponatremia*
Mortality*
Nephrology
Phosphorus
Referral and Consultation
Renal Dialysis*
Retrospective Studies
Sodium
Transplants
Phosphorus
Sodium