Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients

Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients

ABSTRACT Background The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. Met...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Nephrology, dialysis, transplantation dialysis, transplantation, 2023-09, Vol.38 (10), p.2248-2256
Hauptverfasser: Pinter, Jule, Genser, Bernd, Moissl, Ulrich, Stuard, Stefano, Kooman, Jeroen, Canaud, Bernard, Wanner, Christoph
Format: Artikel
Sprache:eng
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 2256
container_issue 10
container_start_page 2248
container_title Nephrology, dialysis, transplantation
container_volume 38
creator Pinter, Jule
Genser, Bernd
Moissl, Ulrich
Stuard, Stefano
Kooman, Jeroen
Canaud, Bernard
Wanner, Christoph
description ABSTRACT Background The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. Methods We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72 163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as >2.5 L above, and −1.1 L below normal fluid status, respectively. N = 2 272 041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death. Results Mortality risk of hyponatremia (plasma sodium
doi_str_mv 10.1093/ndt/gfad041
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2781619624</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ndt/gfad041</oup_id><sourcerecordid>2781619624</sourcerecordid><originalsourceid>FETCH-LOGICAL-c320t-e2898acc632b66af56fbefd639d491ee84825c5eb914b72a074cf4d7effa1ee63</originalsourceid><addsrcrecordid>eNp9kD1PwzAURS0EoqUwsSNPCAmF2k7iJCOq-JIqscAcvcTPrSGJg-2A8u8JamFkusM9OsMh5JyzG86KeNmpsNxoUCzhB2TOE8kiEefpIZlPL49YyooZOfH-jTFWiCw7JrNY5pLHIp-T6nHsbQfBAbYGKHSK6mYwitpPdI0FRcEhBe9tbSCgol8mbOnWbLboqDP-nVpNW-sCNCaM1HRUGWhGbzztIRjsgj8lRxoaj2f7XZDX-7uX1WO0fn54Wt2uozoWLEQo8iKHupaxqKQEnUpdoVYyLlRScMQ8yUVap1gVPKkyASxLap2oDLWG6ZbxglztvL2zHwP6ULbG19g00KEdfCmynEteSJFM6PUOrZ313qEue2dacGPJWfkTtZyilvuoE32xFw9Vi-qP_a04AZc7wA79v6ZvMy2C-Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2781619624</pqid></control><display><type>article</type><title>Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Pinter, Jule ; Genser, Bernd ; Moissl, Ulrich ; Stuard, Stefano ; Kooman, Jeroen ; Canaud, Bernard ; Wanner, Christoph</creator><creatorcontrib>Pinter, Jule ; Genser, Bernd ; Moissl, Ulrich ; Stuard, Stefano ; Kooman, Jeroen ; Canaud, Bernard ; Wanner, Christoph</creatorcontrib><description>ABSTRACT Background The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. Methods We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72 163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as &gt;2.5 L above, and −1.1 L below normal fluid status, respectively. N = 2 272 041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death. Results Mortality risk of hyponatremia (plasma sodium &lt;135 mmol/L) was slightly increased when fluid status was normal [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.18–1.35], increased by half when patients were fluid depleted (HR 1.56, 95% CI 1.27–1.93) and accelerated during fluid overload (HR 1.97, 95% CI 1.82–2.12). Conclusions Plasma sodium and fluid status act independently as risk factors on mortality. Patient surveillance of fluid status is especially important in the high-risk subpopulation of patients with hyponatremia. Prospective patient-level studies should examine the effects of chronic hypo- and hypernatremia, risk determinants, and their outcome risk. Graphical Abstract Graphical Abstract</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfad041</identifier><identifier>PMID: 36861328</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>Nephrology, dialysis, transplantation, 2023-09, Vol.38 (10), p.2248-2256</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c320t-e2898acc632b66af56fbefd639d491ee84825c5eb914b72a074cf4d7effa1ee63</citedby><cites>FETCH-LOGICAL-c320t-e2898acc632b66af56fbefd639d491ee84825c5eb914b72a074cf4d7effa1ee63</cites><orcidid>0000-0002-9546-4507 ; 0000-0001-6854-2816 ; 0000-0001-9507-5301</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1583,27915,27916</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36861328$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pinter, Jule</creatorcontrib><creatorcontrib>Genser, Bernd</creatorcontrib><creatorcontrib>Moissl, Ulrich</creatorcontrib><creatorcontrib>Stuard, Stefano</creatorcontrib><creatorcontrib>Kooman, Jeroen</creatorcontrib><creatorcontrib>Canaud, Bernard</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><title>Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>ABSTRACT Background The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. Methods We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72 163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as &gt;2.5 L above, and −1.1 L below normal fluid status, respectively. N = 2 272 041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death. Results Mortality risk of hyponatremia (plasma sodium &lt;135 mmol/L) was slightly increased when fluid status was normal [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.18–1.35], increased by half when patients were fluid depleted (HR 1.56, 95% CI 1.27–1.93) and accelerated during fluid overload (HR 1.97, 95% CI 1.82–2.12). Conclusions Plasma sodium and fluid status act independently as risk factors on mortality. Patient surveillance of fluid status is especially important in the high-risk subpopulation of patients with hyponatremia. Prospective patient-level studies should examine the effects of chronic hypo- and hypernatremia, risk determinants, and their outcome risk. Graphical Abstract Graphical Abstract</description><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kD1PwzAURS0EoqUwsSNPCAmF2k7iJCOq-JIqscAcvcTPrSGJg-2A8u8JamFkusM9OsMh5JyzG86KeNmpsNxoUCzhB2TOE8kiEefpIZlPL49YyooZOfH-jTFWiCw7JrNY5pLHIp-T6nHsbQfBAbYGKHSK6mYwitpPdI0FRcEhBe9tbSCgol8mbOnWbLboqDP-nVpNW-sCNCaM1HRUGWhGbzztIRjsgj8lRxoaj2f7XZDX-7uX1WO0fn54Wt2uozoWLEQo8iKHupaxqKQEnUpdoVYyLlRScMQ8yUVap1gVPKkyASxLap2oDLWG6ZbxglztvL2zHwP6ULbG19g00KEdfCmynEteSJFM6PUOrZ313qEue2dacGPJWfkTtZyilvuoE32xFw9Vi-qP_a04AZc7wA79v6ZvMy2C-Q</recordid><startdate>20230929</startdate><enddate>20230929</enddate><creator>Pinter, Jule</creator><creator>Genser, Bernd</creator><creator>Moissl, Ulrich</creator><creator>Stuard, Stefano</creator><creator>Kooman, Jeroen</creator><creator>Canaud, Bernard</creator><creator>Wanner, Christoph</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9546-4507</orcidid><orcidid>https://orcid.org/0000-0001-6854-2816</orcidid><orcidid>https://orcid.org/0000-0001-9507-5301</orcidid></search><sort><creationdate>20230929</creationdate><title>Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients</title><author>Pinter, Jule ; Genser, Bernd ; Moissl, Ulrich ; Stuard, Stefano ; Kooman, Jeroen ; Canaud, Bernard ; Wanner, Christoph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-e2898acc632b66af56fbefd639d491ee84825c5eb914b72a074cf4d7effa1ee63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pinter, Jule</creatorcontrib><creatorcontrib>Genser, Bernd</creatorcontrib><creatorcontrib>Moissl, Ulrich</creatorcontrib><creatorcontrib>Stuard, Stefano</creatorcontrib><creatorcontrib>Kooman, Jeroen</creatorcontrib><creatorcontrib>Canaud, Bernard</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pinter, Jule</au><au>Genser, Bernd</au><au>Moissl, Ulrich</au><au>Stuard, Stefano</au><au>Kooman, Jeroen</au><au>Canaud, Bernard</au><au>Wanner, Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2023-09-29</date><risdate>2023</risdate><volume>38</volume><issue>10</issue><spage>2248</spage><epage>2256</epage><pages>2248-2256</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><abstract>ABSTRACT Background The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear. Methods We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72 163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as &gt;2.5 L above, and −1.1 L below normal fluid status, respectively. N = 2 272 041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death. Results Mortality risk of hyponatremia (plasma sodium &lt;135 mmol/L) was slightly increased when fluid status was normal [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.18–1.35], increased by half when patients were fluid depleted (HR 1.56, 95% CI 1.27–1.93) and accelerated during fluid overload (HR 1.97, 95% CI 1.82–2.12). Conclusions Plasma sodium and fluid status act independently as risk factors on mortality. Patient surveillance of fluid status is especially important in the high-risk subpopulation of patients with hyponatremia. Prospective patient-level studies should examine the effects of chronic hypo- and hypernatremia, risk determinants, and their outcome risk. Graphical Abstract Graphical Abstract</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>36861328</pmid><doi>10.1093/ndt/gfad041</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9546-4507</orcidid><orcidid>https://orcid.org/0000-0001-6854-2816</orcidid><orcidid>https://orcid.org/0000-0001-9507-5301</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 0931-0509
ispartof Nephrology, dialysis, transplantation, 2023-09, Vol.38 (10), p.2248-2256
issn 0931-0509
1460-2385
language eng
recordid cdi_proquest_miscellaneous_2781619624
source Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection
title Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-15T07%3A03%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Hyponatraemia%20and%20fluid%20overload%20are%20associated%20with%20higher%20risk%20of%20mortality%20in%20dialysis%20patients&rft.jtitle=Nephrology,%20dialysis,%20transplantation&rft.au=Pinter,%20Jule&rft.date=2023-09-29&rft.volume=38&rft.issue=10&rft.spage=2248&rft.epage=2256&rft.pages=2248-2256&rft.issn=0931-0509&rft.eissn=1460-2385&rft_id=info:doi/10.1093/ndt/gfad041&rft_dat=%3Cproquest_cross%3E2781619624%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2781619624&rft_id=info:pmid/36861328&rft_oup_id=10.1093/ndt/gfad041&rfr_iscdi=true