Association of serum sodium levels with all-cause and cardiovascular mortality in chronic kidney disease: Results from a prospective observational study
Association of serum sodium levels with all-cause and cardiovascular mortality in chronic kidney disease: Results from a prospective observational study
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DOI：
10.1111/nep.12634
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发表时间：
2016-06-01
期刊：
影响因子：
2.5
通讯作者：
Green, Darren
中科院分区：
文献类型：
--
作者：
Chiu, Diana Yuan Yng;Kalra, Philip A.;Green, Darren
目的：低钠血症的患病率在门诊设置尚未得到彻底探讨，并鲜为人知的预后意义，血钠异常在慢性肾脏病（CKD）patients，特别是适应并发medications.Methods的影响：这是一个前瞻性的观察性研究，非透析依赖性CKD患者在肾脏病诊所管理。对2002年至2012年间参加慢性肾功能不全标准实施研究的患者进行了评估。使用基线钠和12个月时间平均钠进行生存分析，并根据合并症、实验室检查结果和合并用药进行调整。结果：基线时（n = 2093），平均估计肾小球滤过率为32.8 ± 15.9ml/min/1.73 m2，中位年龄为67岁（四分位距56-75），中位血清钠浓度为140（138-142）mmol/l。随访41（18-67）个月后，有684例死亡，174例死于心血管原因;分析了1925个时间平均钠值。在考克斯多变量校正回归分析中，基线低钠血症与全因死亡率独立相关（风险比（HR）1.35，95%置信区间（CI）1.02-1.78，P = 0.04; HR 1.15，95% CI 0.84-1.57，P = 0.39），而高钠血症与全因死亡率无关。时间平均低钠血症和高钠血症的情况相似（HR 2.15，95% CI 1.59-2.91，P
Aims: The prevalence of hyponatraemia in the outpatient setting has not been thoroughly explored, and little is known about the prognostic implication of dysnatraemia in chronic kidney disease (CKD) patients, in particular accommodating the effect of concurrent medications.Methods: This is a prospective observational study of non-dialysis-dependent CKD patients managed in a nephrology clinic. Patients enrolled between 2002 and 2012 in the Chronic Renal Insufficiency Standards Implementation Study were assessed. Survival analyses were performed using baseline sodium and 12-month time-averaged sodium, with adjustment for co-morbid diseases, laboratory findings and concurrent medications.Results: At baseline (n = 2093), mean estimated glomerular filtration rate was 32.8 +/- 15.9ml/min per 1.73 m(2), median age was 67 (interquartile range 56-75) years and median serum sodium concentration was 140 (138-142) mmol/l. After a followup of 41 (18-67) months, therewere 684 deaths, 174 from cardiovascular causes; 1925 time-averaged sodium values were analysed. In the Cox multivariate adjusted regression, baseline hyponatraemia, but not hypernatraemia, was independently associated with all-cause mortality (hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.02-1.78, P = 0.04, and HR 1.15, 95% CI 0.84-1.57, P = 0.39, respectively). This was similarly the case for time-averaged hyponatraemia and hypernatraemia (HR 2.15, 95% CI 1.59-2.91, P