Hyponatremia Predicts New-Onset Cardiovascular Events in Peritoneal Dialysis Patients.
Hyponatremia Predicts New-Onset Cardiovascular Events in Peritoneal Dialysis Patients.
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DOI：
10.1371/journal.pone.0129480
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Chang TI
中科院分区：
文献类型：
--
作者：
Kim HW;Ryu GW;Park CH;Kang EW;Park JT;Han SH;Yoo TH;Shin SK;Kang SW;Choi KH;Han DS;Chang TI
心血管（CV）疾病是腹膜透析（PD）患者发病和死亡的主要原因。低钠血症最近被证明是一个可改变的因素，与PD患者的死亡率增加密切相关。然而，低钠血症对这些患者CV结局的临床影响尚不清楚。为了确定低血清钠水平是否可预测CV疾病的发展，我们对2000年1月至2005年12月期间开始PD的441例事件患者进行了前瞻性观察性研究。测定时间平均血清钠（TA-Na）水平，以研究低钠血症预测这些患者新发CV事件的能力。在平均43.2个月的随访期间，106例（24.0%）患者发生了新发CV事件。TA-Na水平≤ 138 mEq/L的患者开始PD后新发CV事件的累积发生率显著高于TA-Na> 138 mEq/L的患者。校正多个潜在混杂协变量后，发现TA-Na水平升高与CV事件风险显著降低相关（亚分布风险比/1 mEq/L升高，0. 90; 95%置信区间，0. 83 - 0. 96; p = 0. 003）。TA-Na ≤ 138 mEq/L的患者发生CV事件的风险高2.31倍。这些结果提供了证据，证明PD患者开始透析后低血清钠与新发CV事件之间存在明确相关性。针对该适应症纠正低钠血症是否能为这些患者发生CV疾病提供额外的保护，仍有待在干预性研究中解决。
Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients on peritoneal dialysis (PD). Hyponatremia was recently shown to be a modifiable factor that is strongly associated with increased mortality in PD patients. However, the clinical impact of hyponatremia on CV outcomes in these patients is unclear. To determine whether a low serum sodium level predicts the development of CV disease, we carried out a prospective observational study of 441 incident patients who started PD between January 2000 and December 2005. Time-averaged serum sodium (TA-Na) levels were determined to investigate the ability of hyponatremia to predict newly developed CV events in these patients. During a mean follow-up of 43.2 months, 106 (24.0%) patients developed new CV events. The cumulative incidence of new-onset CV events after the initiation of PD was significantly higher in patients with TA-Na levels ≤ 138 mEq/L than in those with a TA-Na > 138 mEq/L. After adjustment for multiple potentially confounding covariates, an increase in TA-Na level was found to be associated with a significantly lower risk of CV events (subdistribution hazard ratio per 1 mEq/L increase, 0.90; 95% confidence interval, 0.83–0.96; p = 0.003). Patients with a TA-Na ≤ 138 mEq/L had a 2.31-fold higher risk of suffering a CV event. These results provide evidence of a clear association between low serum sodium and new-onset CV events after dialysis initiation in PD patients. Whether the correction of hyponatremia for this indication provides additional protection for the development of CV disease in these patients remains to be addressed in interventional studies.
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影响因子：
2.3
作者：
Mandai S;Kuwahara M;Kasagi Y;Kusaka K;Tanaka T;Shikuma S;Akita W;Sasaki S
通讯作者：
Sasaki S
影响因子：
13.2
作者：
Hecking, Manfred;Karaboyas, Angelo;Port, Friedrich K.
通讯作者：
Port, Friedrich K.
影响因子：
2.8
作者：
SCHAER, GL;COVIT, AB;CODY, RJ
通讯作者：
CODY, RJ
影响因子：
158.5
作者：
KATZ, MA
通讯作者：
KATZ, MA
影响因子：
158.5
作者：
SZATALOWICZ, VL;ARNOLD, PE;SCHRIER, RW
通讯作者：
SCHRIER, RW