Mortality associated with low serum sodium concentration in maintenance hemodialysis.
Mortality associated with low serum sodium concentration in maintenance hemodialysis.
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DOI：
10.1016/j.amjmed.2010.07.029
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发表时间：
2011-01
影响因子：
5.9
通讯作者：
Brunelli, Steven M.
中科院分区：
文献类型：
--
作者：
Waikar, Sushrut S.;Curhan, Gary C.;Brunelli, Steven M.
在一般人群中，低血清钠浓度与死亡风险增加相关，但由于临床疾病（如充血性心力衰竭和肝硬化）的混淆，因果关系尚不确定，其中低钠血症是由精氨酸加压素水平升高引起的。为研究终末期肾病（精氨酸加压素不影响水排泄和尿调节）患者透析前血清钠浓度与死亡率之间的关系，我们研究了HEMO研究中的1549例少尿患者，该研究是一项血液透析患者的随机对照试验，旨在研究血液透析剂量和流量的影响。我们使用比例风险模型来比较透析前血清钠浓度的死亡风险。作为连续变量，基线透析前血清钠浓度每增加4 mEq/L，全因死亡率的风险比为0.84（95%置信区间（CI），0.78-0.90）。对人口统计学、临床、实验室和透析特异性协变量（包括超滤量）进行多变量调整后，结果未发生明显变化（全因死亡率的风险比为0.89; 95% CI，0.82-0.96）。在使用血清钠和其他相关协变量重复测量的时间更新分析中，结果也一致。透析前血清钠浓度较低与死亡风险增加相关。考虑到透析人群的独特生理学，这些发现提高了低钠血症本身可能是更广泛人群死亡率的因果决定因素的可能性。
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. 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. 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. 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.
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影响因子：
4.2
作者：
MARTINEZVEA, A;GARCIA, C;OLIVER, JA
通讯作者：
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