Hyponatremia as a predictor of mortality in peritoneal dialysis patients
Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients. This prospective observational study included a total of 441 incident patients who...
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| creator | Chang, Tae Ik Kim, Yung Ly Kim, Hyungwoo Ryu, Geun Woo Kang, Ea Wha Park, Jung Tak Yoo, Tae-Hyun Shin, Sug Kyun Kang, Shin-Wook Choi, Kyu Hun Han, Dae Suk Han, Seung Hyeok |
| description | Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients.
This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients.
Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = -0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73-0.86; p |
| doi_str_mv | 10.1371/journal.pone.0111373 |
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This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients.
Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = -0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73-0.86; p<0.001) and infection-related (HR per 1 mEq/L increase, 0.77; 95% CI, 0.70-0.85; p<0.001) deaths.
This study showed that hyponatremia is an independent predictor of mortality in PD patients. Nevertheless, whether correcting hyponatremia improves patient survival is unknown. Future interventional studies should address this question more appropriately.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0111373</identifier><identifier>PMID: 25354265</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Cardiovascular disease ; Dialysis ; Electrolytes ; Fatalities ; Female ; Glucose ; Heart failure ; Hemodialysis ; Hospitals ; Humans ; Hyponatremia ; Hyponatremia - diagnosis ; Hyponatremia - etiology ; Internal medicine ; Laboratories ; Male ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Nutrition ; Patients ; Peritoneal dialysis ; Peritoneal Dialysis - adverse effects ; Peritoneal Dialysis - mortality ; Peritoneum ; Potassium ; Regression analysis ; Renal function ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - therapy ; Serum albumin ; Sodium ; Studies ; Ultrafiltration</subject><ispartof>PloS one, 2014-10, Vol.9 (10), p.e111373-e111373</ispartof><rights>2014 Chang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Chang et al 2014 Chang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c592t-1d0d541bc01a8c284b8dfe571d4e5537c1e8369bd61acde49b79f225f5b5a16e3</citedby><cites>FETCH-LOGICAL-c592t-1d0d541bc01a8c284b8dfe571d4e5537c1e8369bd61acde49b79f225f5b5a16e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213027/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213027/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25354265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, Tae Ik</creatorcontrib><creatorcontrib>Kim, Yung Ly</creatorcontrib><creatorcontrib>Kim, Hyungwoo</creatorcontrib><creatorcontrib>Ryu, Geun Woo</creatorcontrib><creatorcontrib>Kang, Ea Wha</creatorcontrib><creatorcontrib>Park, Jung Tak</creatorcontrib><creatorcontrib>Yoo, Tae-Hyun</creatorcontrib><creatorcontrib>Shin, Sug Kyun</creatorcontrib><creatorcontrib>Kang, Shin-Wook</creatorcontrib><creatorcontrib>Choi, Kyu Hun</creatorcontrib><creatorcontrib>Han, Dae Suk</creatorcontrib><creatorcontrib>Han, Seung Hyeok</creatorcontrib><title>Hyponatremia as a predictor of mortality in peritoneal dialysis patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients.
This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients.
Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = -0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73-0.86; p<0.001) and infection-related (HR per 1 mEq/L increase, 0.77; 95% CI, 0.70-0.85; p<0.001) deaths.
This study showed that hyponatremia is an independent predictor of mortality in PD patients. Nevertheless, whether correcting hyponatremia improves patient survival is unknown. Future interventional studies should address this question more appropriately.</description><subject>Adult</subject><subject>Aged</subject><subject>Cardiovascular disease</subject><subject>Dialysis</subject><subject>Electrolytes</subject><subject>Fatalities</subject><subject>Female</subject><subject>Glucose</subject><subject>Heart failure</subject><subject>Hemodialysis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyponatremia</subject><subject>Hyponatremia - diagnosis</subject><subject>Hyponatremia - etiology</subject><subject>Internal medicine</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nutrition</subject><subject>Patients</subject><subject>Peritoneal dialysis</subject><subject>Peritoneal Dialysis - adverse effects</subject><subject>Peritoneal Dialysis - mortality</subject><subject>Peritoneum</subject><subject>Potassium</subject><subject>Regression analysis</subject><subject>Renal function</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>Serum albumin</subject><subject>Sodium</subject><subject>Studies</subject><subject>Ultrafiltration</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptkk1v1DAQhiNERUvhHyCIxIXLbj3-SnJBQhWwlSr1Us6WPybFKycOtrfS_nuy3bRqESdb43eemdd6q-oDkDWwBi62cZdGHdZTHHFNAOYie1WdQcfoSlLCXj-7n1Zvc94SIlgr5ZvqlAomOJXirNps9jNAl4SD17XOta6nhM7bElMd-3qIqejgy772Yz1h8mUep0PtvA777HM96eJxLPldddLrkPH9cp5Xv358v73crK5vfl5dfrteWdHRsgJHnOBgLAHdWtpy07oeRQOOoxCssYAtk51xErR1yDvTdD2lohdGaJDIzqtPR-4UYlbLJ2QFEloQlHM5K66OChf1Vk3JDzrtVdRePRRiulM6FW8DKk6c6yhFoCi56E1HewOcG4NGAmn6mfV1mbYzAzo7O006vIC-fBn9b3UX7xWnwAhtZsCXBZDinx3mogafLYagR4y7h707Bg3nB-nnf6T_d8ePKptizgn7p2WAqEMwHrvUIRhqCcbc9vG5kaemxySwv3fSt2g</recordid><startdate>20141029</startdate><enddate>20141029</enddate><creator>Chang, Tae Ik</creator><creator>Kim, Yung Ly</creator><creator>Kim, Hyungwoo</creator><creator>Ryu, Geun Woo</creator><creator>Kang, Ea Wha</creator><creator>Park, Jung Tak</creator><creator>Yoo, Tae-Hyun</creator><creator>Shin, Sug Kyun</creator><creator>Kang, Shin-Wook</creator><creator>Choi, Kyu Hun</creator><creator>Han, Dae Suk</creator><creator>Han, Seung Hyeok</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20141029</creationdate><title>Hyponatremia as a predictor of mortality in peritoneal dialysis patients</title><author>Chang, Tae Ik ; Kim, Yung Ly ; Kim, Hyungwoo ; Ryu, Geun Woo ; Kang, Ea Wha ; Park, Jung Tak ; Yoo, Tae-Hyun ; Shin, Sug Kyun ; Kang, Shin-Wook ; Choi, Kyu Hun ; Han, Dae Suk ; Han, Seung Hyeok</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c592t-1d0d541bc01a8c284b8dfe571d4e5537c1e8369bd61acde49b79f225f5b5a16e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cardiovascular disease</topic><topic>Dialysis</topic><topic>Electrolytes</topic><topic>Fatalities</topic><topic>Female</topic><topic>Glucose</topic><topic>Heart failure</topic><topic>Hemodialysis</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hyponatremia</topic><topic>Hyponatremia - diagnosis</topic><topic>Hyponatremia - etiology</topic><topic>Internal medicine</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nutrition</topic><topic>Patients</topic><topic>Peritoneal dialysis</topic><topic>Peritoneal Dialysis - adverse effects</topic><topic>Peritoneal Dialysis - mortality</topic><topic>Peritoneum</topic><topic>Potassium</topic><topic>Regression analysis</topic><topic>Renal function</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>Serum albumin</topic><topic>Sodium</topic><topic>Studies</topic><topic>Ultrafiltration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, Tae Ik</creatorcontrib><creatorcontrib>Kim, Yung Ly</creatorcontrib><creatorcontrib>Kim, Hyungwoo</creatorcontrib><creatorcontrib>Ryu, Geun Woo</creatorcontrib><creatorcontrib>Kang, Ea Wha</creatorcontrib><creatorcontrib>Park, Jung Tak</creatorcontrib><creatorcontrib>Yoo, Tae-Hyun</creatorcontrib><creatorcontrib>Shin, Sug Kyun</creatorcontrib><creatorcontrib>Kang, Shin-Wook</creatorcontrib><creatorcontrib>Choi, Kyu Hun</creatorcontrib><creatorcontrib>Han, Dae Suk</creatorcontrib><creatorcontrib>Han, Seung Hyeok</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection (ProQuest)</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, Tae Ik</au><au>Kim, Yung Ly</au><au>Kim, Hyungwoo</au><au>Ryu, Geun Woo</au><au>Kang, Ea Wha</au><au>Park, Jung Tak</au><au>Yoo, Tae-Hyun</au><au>Shin, Sug Kyun</au><au>Kang, Shin-Wook</au><au>Choi, Kyu Hun</au><au>Han, Dae Suk</au><au>Han, Seung Hyeok</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyponatremia as a predictor of mortality in peritoneal dialysis patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-10-29</date><risdate>2014</risdate><volume>9</volume><issue>10</issue><spage>e111373</spage><epage>e111373</epage><pages>e111373-e111373</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients.
This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients.
Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = -0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73-0.86; p<0.001) and infection-related (HR per 1 mEq/L increase, 0.77; 95% CI, 0.70-0.85; p<0.001) deaths.
This study showed that hyponatremia is an independent predictor of mortality in PD patients. Nevertheless, whether correcting hyponatremia improves patient survival is unknown. Future interventional studies should address this question more appropriately.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25354265</pmid><doi>10.1371/journal.pone.0111373</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Cardiovascular disease Dialysis Electrolytes Fatalities Female Glucose Heart failure Hemodialysis Hospitals Humans Hyponatremia Hyponatremia - diagnosis Hyponatremia - etiology Internal medicine Laboratories Male Medicine Medicine and Health Sciences Middle Aged Mortality Nutrition Patients Peritoneal dialysis Peritoneal Dialysis - adverse effects Peritoneal Dialysis - mortality Peritoneum Potassium Regression analysis Renal function Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - therapy Serum albumin Sodium Studies Ultrafiltration |
| title | Hyponatremia as a predictor of mortality in peritoneal dialysis patients |
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