November 14, 2016Open Access

Hyponatremia is Associated with Fluid Imbalance and Adverse Renal Outcome in Chronic Kidney Disease Patients Treated with Diuretics

Structured PICO

Does hyponatremia predict adverse renal outcomes (renal replacement therapy) in patients with chronic kidney disease treated with diuretics?

Population

4,766 patients with chronic kidney disease (CKD) stages 1-5 not on dialysis, including 1,009 diuretic users and 3,757 non-users. Mean age 64.0 years (diuretic users), 49.6% female (diuretic users). Based in Taiwan.

Intervention

Hyponatremia (serum sodium <135 mEq/L) in the context of diuretic use (loop diuretics >39 mg/day furosemide equivalent or thiazide >3.9 mg/day trichlormethiazide equivalent)

Comparator

Normonatremia (serum sodium 135-138 mEq/L) and/or diuretic non-users

Outcome

Renal replacement therapy (initiation of hemodialysis, peritoneal dialysis, or renal transplantation)hard clinical

Hyponatremia is an indicator of fluid imbalance and an independent prognostic factor for requiring renal replacement therapy in CKD patients treated with diuretics.

Abstract

Chronic kidney disease (CKD) is frequently complicated with hyponatremia, probably because of fluid overload or diuretic usage. Hyponatremia in CKD population is associated with increased mortality, but the effect on renal outcome was unknown. We investigated whether hyponatremia is associated with fluid status and is a prognostic indicator for adverse outcomes in a CKD cohort of 4,766 patients with 1,009 diuretic users. We found that diuretic users had worse clinical outcomes compared with diuretic non-users. Hyponatremia (serum sodium 141 mEq/L) was associated with an increased risk for all-cause mortality. Thus, hyponatremia is an indicator of fluid imbalance and also a prognostic factor for renal replacement therapy in CKD patients treated with diuretics.

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