Cargando…

Hyponatremia in the Dialysis Population

Sodium derangements are among the most frequently encountered electrolyte disorders in patients with end-stage renal disease. As dialysis patients are predisposed to hyponatremia via multiple pathways, assessment of extracellular volume status is an essential first step in disentangling potential et...

Descripción completa

Detalles Bibliográficos
Autores principales: Rhee, Connie M., Ayus, Juan Carlos, Kalantar-Zadeh, Kamyar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551474/
https://www.ncbi.nlm.nih.gov/pubmed/31194059
http://dx.doi.org/10.1016/j.ekir.2019.02.012
_version_ 1783424396626493440
author Rhee, Connie M.
Ayus, Juan Carlos
Kalantar-Zadeh, Kamyar
author_facet Rhee, Connie M.
Ayus, Juan Carlos
Kalantar-Zadeh, Kamyar
author_sort Rhee, Connie M.
collection PubMed
description Sodium derangements are among the most frequently encountered electrolyte disorders in patients with end-stage renal disease. As dialysis patients are predisposed to hyponatremia via multiple pathways, assessment of extracellular volume status is an essential first step in disentangling potential etiologic factors. In addition, multiple large population-based studies indicate that proxies of malnutrition (e.g., low body mass index, serum albumin, and serum creatinine levels) and loss of residual kidney function are important determinants of hyponatremia in dialysis patients. Among hemodialysis and peritoneal dialysis patients, evidence suggests that incrementally lower sodium levels are associated with increasingly higher death risk, highlighting the long-term risk of hyponatremia. Whereas in conventional survival models incrementally lower serum sodium concentrations are associated with worse mortality in hemodialysis patients, studies that have examined repeated measures of predialysis sodium have demonstrated mixed associations of time-varying sodium with higher mortality risk (i.e., U-shaped vs. inverse linear relationships). Although the causality of the hyponatremia-mortality association in dialysis patients remains uncertain, there are several plausible pathways by which lower sodium levels may lead to higher death risk, including central nervous system toxicity, falls and fractures, infection-related complications, and impaired cardiac function. Areas of uncertainty ripe for future studies include the following: (i) mechanistic pathways by which lower serum sodium levels are linked with higher mortality in dialysis patients, (ii) whether correction of sodium derangements improves outcomes, (iii) the optimal sodium target, and (iv) the impact of age and other sociodemographic factors on hyponatremia-outcome associations.
format Online
Article
Text
id pubmed-6551474
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-65514742019-06-10 Hyponatremia in the Dialysis Population Rhee, Connie M. Ayus, Juan Carlos Kalantar-Zadeh, Kamyar Kidney Int Rep Review Sodium derangements are among the most frequently encountered electrolyte disorders in patients with end-stage renal disease. As dialysis patients are predisposed to hyponatremia via multiple pathways, assessment of extracellular volume status is an essential first step in disentangling potential etiologic factors. In addition, multiple large population-based studies indicate that proxies of malnutrition (e.g., low body mass index, serum albumin, and serum creatinine levels) and loss of residual kidney function are important determinants of hyponatremia in dialysis patients. Among hemodialysis and peritoneal dialysis patients, evidence suggests that incrementally lower sodium levels are associated with increasingly higher death risk, highlighting the long-term risk of hyponatremia. Whereas in conventional survival models incrementally lower serum sodium concentrations are associated with worse mortality in hemodialysis patients, studies that have examined repeated measures of predialysis sodium have demonstrated mixed associations of time-varying sodium with higher mortality risk (i.e., U-shaped vs. inverse linear relationships). Although the causality of the hyponatremia-mortality association in dialysis patients remains uncertain, there are several plausible pathways by which lower sodium levels may lead to higher death risk, including central nervous system toxicity, falls and fractures, infection-related complications, and impaired cardiac function. Areas of uncertainty ripe for future studies include the following: (i) mechanistic pathways by which lower serum sodium levels are linked with higher mortality in dialysis patients, (ii) whether correction of sodium derangements improves outcomes, (iii) the optimal sodium target, and (iv) the impact of age and other sociodemographic factors on hyponatremia-outcome associations. Elsevier 2019-03-01 /pmc/articles/PMC6551474/ /pubmed/31194059 http://dx.doi.org/10.1016/j.ekir.2019.02.012 Text en © 2019 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review
Rhee, Connie M.
Ayus, Juan Carlos
Kalantar-Zadeh, Kamyar
Hyponatremia in the Dialysis Population
title Hyponatremia in the Dialysis Population
title_full Hyponatremia in the Dialysis Population
title_fullStr Hyponatremia in the Dialysis Population
title_full_unstemmed Hyponatremia in the Dialysis Population
title_short Hyponatremia in the Dialysis Population
title_sort hyponatremia in the dialysis population
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551474/
https://www.ncbi.nlm.nih.gov/pubmed/31194059
http://dx.doi.org/10.1016/j.ekir.2019.02.012
work_keys_str_mv AT rheeconniem hyponatremiainthedialysispopulation
AT ayusjuancarlos hyponatremiainthedialysispopulation
AT kalantarzadehkamyar hyponatremiainthedialysispopulation