Predialysis Serum Sodium Level, Dialysate Sodium, and Mortality in Maintenance Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)
Predialysis Serum Sodium Level, Dialysate Sodium, and Mortality in Maintenance Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)
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DOI：
10.1053/j.ajkd.2011.07.013
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发表时间：
2012-02-01
影响因子：
13.2
通讯作者：
Port, Friedrich K.
中科院分区：
文献类型：
--
作者：
Hecking, Manfred;Karaboyas, Angelo;Port, Friedrich K.
背景资料：透析前血清钠浓度最近已与血液透析患者的患者特征和结果联系起来，并可能对透析液钠处方产生影响。研究设计：前瞻性队列研究。参与者：来自12个国家的11，555例透析结果和实践模式研究（DOPPS）患者，I期（1996-2001年）和第三次（2005-2008）。预测因素：人口统计学、共病状况、实验室测量（模型1）;平均血清钠水平、透析液钠浓度（模型2）。结局：血清钠水平，使用校正线性混合模型（模型1）;全因死亡率，使用考克斯比例风险模型（模型2）。结果：中位随访时间为12个月，研究期间（12，274患者年）发生1，727例死亡（15%）。DOPPS国家的平均血清钠水平为138.5 +/- 2.8 mEq/L。日本的平均血清钠水平最高（139.1 +/- 2.6 mEq/L），澳大利亚/新西兰的平均血清钠水平最低（137.4 +/- 2.8 mEq/L）。血清钠水平与男性、黑人、体重指数、血清白蛋白水平和肌酐水平呈正相关，与神经系统和精神疾病、白色血细胞计数和透析中体重减轻呈负相关（每减轻1%，体重减轻0.16 mEq/L）。在连续模型中，较高的血清钠水平与较低的校正全因死亡率相关（HR，每升高1 mEq/L 0.95; 95% CI，0.93-0.97）。透析液钠处方与血清钠水平无关。死亡率分析仅限于死亡率最高的血清钠三分位数（血清钠140 mEq/L）。局限性：在本观察性研究中无法确定因果关系，该研究未考虑透析液钠水平对透析后口渴、饮食盐和水摄入量、透析间期体重增加和心血管稳定性的潜在影响。较低的血清钠水平与血液透析患者的某些特征和较高的校正死亡风险相关。在我们的校正分析中，在血清钠水平140 mEq/L的患者中观察到的较低死亡率令人感兴趣，可能与透析中心血管稳定性有关，值得进一步研究。美国肾脏病杂志59（2）：238-248。(C)2012年，美国国家肾脏基金会（National Kidney Foundation，Inc.）爱思唯尔公司出版All rights reserved.
Background: Predialysis serum sodium concentrations recently have been linked to patient characteristics and outcomes in hemodialysis patients and may have implications for the dialysate sodium prescription.Study Design: Prospective cohort study.Participants: 11,555 patients from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS), phases I (1996-2001) and III (2005-2008).Predictors: Demographics, comorbid conditions, laboratory measurements (model 1); mean serum sodium level, dialysate sodium concentration (model 2).Outcomes: Serum sodium level, using adjusted linear mixed models (model 1); all-cause mortality, using Cox proportional hazards models (model 2).Results: Median follow-up was 12 months, with 1,727 deaths (15%) occurring during the study period (12,274 patient-years). Mean serum sodium level in the DOPPS countries was 138.5 +/- 2.8 mEq/L. Japan had the highest (139.1 +/- 2.6 mEq/L) and Australia/New Zealand had the lowest mean serum sodium level (137.4 +/- 2.8 mEq/L). Serum sodium level was associated positively with male sex, black race, body mass index, serum albumin level, and creatinine level and negatively with neurologic and psychiatric disease, white blood cell count, and intradialytic weight loss (0.16 mEq/L lower per 1% loss). Higher serum sodium level was associated with lower adjusted all-cause mortality in a continuous model (HR, 0.95 per 1 mEq/L higher; 95% CI, 0.93-0.97). Dialysate sodium prescription was not associated with serum sodium level. Mortality analyses restricted to the serum sodium tertile with the highest mortality (serum sodium 140 mEq/L.Limitations: Causality cannot be established in this observational study, which does not consider potential effects of dialysate sodium level on postdialysis thirst, dietary salt and water intake, interdialytic weight gain, and cardiovascular stability.Conclusions: Lower serum sodium levels are associated with certain hemodialysis patient characteristics and higher adjusted risk of death. The lower mortality observed in our adjusted analyses in patients with serum sodium levels 140 mEq/L is intriguing, may be related to intradialytic cardiovascular stability, and deserves further study. Am J Kidney Dis. 59(2): 238-248. (C) 2012 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.