Serum sodium levels <130 mEq/L and ≥150 mEq/L were associated with increased all-cause mortality compared to 136-145 mEq/L (HR 1.93, 95% CI 1.83-2.03 and HR 1.56, 95% CI 1.33-1.83; P<0.001).
Cohort (n=655,493)
Yes
Are abnormal serum sodium concentrations associated with increased all-cause mortality in patients with non-dialysis-dependent chronic kidney disease with and without congestive heart failure?
Both hyponatremia and hypernatremia are independently associated with higher all-cause mortality in patients with non-dialysis-dependent chronic kidney disease, regardless of the presence of congestive heart failure.
Hazard Ratio: 1.93 (95% CI 1.83–2.03)
p-value: p=<0.001
BACKGROUND: Hyponatremia is common in patients with conditions such as congestive heart failure and is associated with increased mortality in hospitalized patients. Congestive heart failure is common in patients with chronic kidney disease, but the association of serum sodium concentration with mortality in such patients is not well characterized. METHODS AND RESULTS: We examined the association of serum sodium concentration with all-cause mortality in a nationally representative cohort of 655 493 US veterans with non-dialysis-dependent chronic kidney disease (95 961 15% of them with congestive heart failure). Associations were examined in time-dependent Cox models with adjustment for potential confounders. During a median follow-up of 5.5 years, a total of 193 956 patients died (mortality rate, 62.5/1000 patient-years; 95% confidence interval, 62.2-62.8). The association of serum sodium level with mortality was U-shaped, with the lowest mortality seen in patients with sodium level of 140 mEq/L and with both lower and higher levels showing significant associations with increased mortality. Patients with serum sodium levels of <130, 130 to 135.9, 145.1 to 150, and ≥150 mEq/L compared with 136 to 145 mEq/L had multivariable-adjusted mortality hazard ratios (95% confidence interval) of 1.93 (1.83-2.03), 1.28 (1.26-1.30), 1.33 (1.28-1.38), and 1.56 (1.33-1.83) (P<0.001 for all). The associations remained consistent in subgroups of patients with and without congestive heart failure. CONCLUSIONS: Both lower and higher serum sodium levels are independently associated with higher mortality in patients with non-dialysis-dependent chronic kidney disease, irrespective of the presence or absence of congestive heart failure.
Kövesdy et al. (Fri,) conducted a cohort in chronic kidney disease (n=655,493). Abnormal serum sodium concentration vs. Serum sodium level of 136 to 145 mEq/L was evaluated on all-cause mortality (HR 1.93, 95% CI 1.83-2.03, p=<0.001). Serum sodium levels <130 mEq/L and ≥150 mEq/L were associated with increased all-cause mortality compared to 136-145 mEq/L (HR 1.93, 95% CI 1.83-2.03 and HR 1.56, 95% CI 1.33-1.83; P<0.001).