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Hyponatraemia predicts the acute (type 1) cardio-renal syndrome

Doron Aronson1, Wisam Darawsha, Marina Promyslovsky

  • 1Department of Cardiology, Rambam Medical Center, Haifa, Israel.

European Journal of Heart Failure
|July 26, 2013
PubMed

Insights

Hyponatraemia, or low sodium levels, predicts worsening renal function (WRF) in patients with acute heart failure or heart attacks. This finding highlights the role of congestion and neurohormonal activation in cardio-renal syndrome.

Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Acute (type 1) cardio-renal syndrome (CRS) involves worsening heart and kidney function, often complicating acute decompensated heart failure (ADHF) and acute myocardial infarction (AMI).
  • Hyponatraemia (low sodium levels) is a potential marker for congestion, hemodilution, and neurohormonal activation in CRS.
  • Identifying patients at risk for worsening renal function (WRF) is crucial for managing CRS.

Purpose of the Study:

  • To investigate if hyponatraemia can identify patients at risk for developing WRF.
  • To assess the association between hyponatraemia and WRF in patients with ADHF and AMI.

Main Methods:

  • Two cohorts were studied: patients with ADHF (n=525) and patients with AMI (n=2576).
  • Hyponatraemia was defined as serum sodium <136 mmol/L.
  • WRF was defined as an increase in creatinine >0.3 mg/dL above baseline.
  • Multivariable logistic regression was used to analyze the association between hyponatraemia and WRF.

Main Results:

  • Hyponatraemia was present in 19.7% of ADHF patients and 17.7% of AMI patients upon admission.
  • Hyponatraemia was significantly more frequent in patients who developed WRF compared to those who did not, in both ADHF (34.6% vs. 22.2%) and AMI (29.7% vs. 21.8%) cohorts.
  • Multivariable analysis showed hyponatraemia was an independent predictor of WRF in both ADHF (OR 1.90) and AMI (OR 1.56) cohorts.
  • The increased mortality risk associated with hyponatraemia was reduced when WRF was absent.

Conclusions:

  • Hyponatraemia is a significant predictor of WRF in patients experiencing ADHF and AMI, key scenarios for type 1 CRS.
  • These findings support the role of congestion and neurohormonal activation in the pathophysiology of acute cardio-renal failure.
  • Hyponatraemia may serve as a valuable clinical marker for risk stratification in patients with acute cardiac conditions.
Abstract

Keywords:
Acute heart failureAcute myocardial infarctionCardio-renal syndromesWorsening renal function

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