Lower serum sodium level predicts higher risk of infection-related hospitalization in maintenance hemodialysis patients: an observational cohort study.
Lower serum sodium level predicts higher risk of infection-related hospitalization in maintenance hemodialysis patients: an observational cohort study.
复制标题
DOI：
10.1186/1471-2369-14-276
复制
发表时间：
2013-12-19
期刊：
影响因子：
2.3
通讯作者：
Sasaki S
中科院分区：
文献类型：
--
作者：
Mandai S;Kuwahara M;Kasagi Y;Kusaka K;Tanaka T;Shikuma S;Akita W;Sasaki S
低钠血症与伴有或不伴有终末期肾病 (ESRD) 的慢性肾病死亡率增加相关。越来越多的证据表明，低钠血症不仅是严重基础疾病的标志，也是导致死亡的直接因素。然而，导致低钠血症人群死亡的具体发病机制或疾病尚不清楚。本研究旨在阐明终末期肾病患者血清钠水平（sNa）与感染风险之间的关系。这项观察性队列研究包括 2009 年 5 月在我们的透析室接受维持性血液透析的 332 名患者。2009 年 5 月、6 月和 7 月每次透析前 3 个月的葡萄糖校正 sNa 测量值的平均值用作基线 sNa。主要终点是首次感染相关住院治疗（IRH），次要终点是任何原因的死亡。使用 Cox 危害模型分析数据，并根据基线人口统计和特征或实验室数据进行调整。对患者进行随访，直至 2013 年 1 月 31 日转移、肾移植、死亡或研究结束。平均 sNa 为 138.9 mEq/L（第一三分位数：<138.0，n = 104；第二三分位数：138.0–140.0，n = 116；第三三分位数：>140.0， n = 112）。在 39.5 个月的平均随访期间，57 名患者经历了 IRH（总体为 56.4/1,000 患者年；第一三分位数为 89.7/1,000；第二三分位数为 57.9/1,000；第三三分位数为 28.0/1,000），68 名患者死亡。第一和第二三分位数的 IRH 风险比 (HR) 高于第三三分位数（未经调整的 HR，3.20；95% 置信区间 (CI)，1.54–6.64；p = 0.002；调整后的 HR，2.36；95% CI，1.10–5.04； p = 0.027；未调整 HR，2.07；95% CI，0.98–4.40；p = 0.058；调整后 HR，2.11；95% CI，0.99–4.51）。在连续模型中，较高的 sNa 与较低的 IRH 风险（调整后的 HR，0.90；95% CI，0.81–0.99；p = 0.040）和较低的全因死亡率相关（调整后的 HR，0.91；95% CI，0.83–1.00；p = 0.049）。较低的 sNa 是维持性血液透析患者感染相关住院风险较高的独立预测因子。传染病可能是 ESRD 低钠血症人群死亡率增加的部分原因。
Hyponatremia is associated with increased mortality in chronic kidney disease with and without end-stage renal disease (ESRD). Increasing evidence suggests that hyponatremia is not only a marker of severe underlying disease, but also a direct contributor to mortality. However, specific pathogenesis or diseases contributing to mortality in the hyponatremic population are unknown. This study aimed to clarify the relationship between serum sodium level (sNa) and infection risk in ESRD patients. This observational cohort study included 332 patients on maintenance hemodialysis in our dialysis unit in May 2009. The mean of 3 monthly measurements of glucose-corrected sNa before each dialysis session in May, June, and July 2009 was applied as baseline sNa. The primary endpoint was first infection-related hospitalization (IRH), and the secondary endpoint was death of any cause. Data were analyzed using Cox hazards modeling, adjusted for baseline demographics and characteristics, or laboratory data. Patients were followed until transfer, kidney transplantation, death, or study end on January 31, 2013. Mean sNa was 138.9 mEq/L (1st tertile: <138.0, n = 104; 2nd tertile: 138.0–140.0, n = 116; 3rd tertile: >140.0, n = 112). During 39.5 months’ mean follow-up, 57 patients experienced IRH (56.4/1,000 patient-years overall; 89.7/1,000 in 1st tertile; 57.9/1,000 in 2nd tertile; 28.0/1,000 in 3rd tertile), and 68 patients died. The hazard ratio (HR) for IRH was higher for the 1st and 2nd tertiles than the 3rd tertile (unadjusted HR, 3.20; 95% confidence interval (CI), 1.54–6.64; p = 0.002; adjusted HR, 2.36; 95% CI, 1.10–5.04; p = 0.027; and unadjusted HR, 2.07; 95% CI, 0.98–4.40; p = 0.058; adjusted HR, 2.11; 95% CI, 0.99–4.51; p = 0.054 respectively). In a continuous model, higher sNa was associated with lower risk of IRH (adjusted HR, 0.90; 95% CI, 0.81–0.99; p = 0.040), and lower all-cause mortality (adjusted HR, 0.91; 95% CI, 0.83–1.00; p = 0.049). Lower sNa is an independent predictor of higher risk for infection-related hospitalization in maintenance hemodialysis patients. Infectious disease may partially account for the increased mortality observed in the hyponatremic population with ESRD.
登录
查看更多内容
影响因子：
5.9
作者：
Liamis, George;Rodenburg, Eline M.;Hoorn, Ewout J.
通讯作者：
Hoorn, Ewout J.
影响因子：
6.2
作者：
Hoorn, Ewout J.;Rivadeneira, Fernando;Zillikens, M. Carola
通讯作者：
Zillikens, M. Carola
影响因子：
38.9
作者：
Funk, Georg-Christian;Lindner, Gregor;Metnitz, Philipp G. H.
通讯作者：
Metnitz, Philipp G. H.
影响因子：
13.2
作者：
Hecking, Manfred;Karaboyas, Angelo;Port, Friedrich K.
通讯作者：
Port, Friedrich K.
DOI：
10.1164/rccm.201003-0481oc
发表时间：
2010-11-01
影响因子：
24.7
作者：
Scherz, Nathalie;Labarere, Jose;Aujesky, Drahomir
通讯作者：
Aujesky, Drahomir