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Hyponatremia in the Dialysis Population.
Connie M Rhee1, Juan Carlos Ayus1,2, Kamyar Kalantar-Zadeh1,3
1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA.
Kidney International Reports
|June 14, 2019
Summary
Hyponatremia, or low sodium levels, is common in dialysis patients and linked to increased mortality risk. Further research is needed to understand the causes and optimal treatment for this electrolyte disorder.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Research
Background:
- Sodium derangements, particularly hyponatremia, are prevalent in end-stage renal disease (ESRD) patients undergoing dialysis.
- Dialysis patients face multiple risk factors for hyponatremia, necessitating careful assessment of extracellular volume status.
Purpose of the Study:
- To review the determinants and mortality associations of hyponatremia in dialysis patients.
- To identify areas for future research regarding hyponatremia in this population.
Main Methods:
- Review of large population-based studies and survival models.
- Analysis of factors such as body mass index, serum albumin, serum creatinine, and residual kidney function.
- Examination of associations between predialysis sodium levels and mortality risk.
Main Results:
- Low serum sodium levels in hemodialysis and peritoneal dialysis patients are associated with increased death risk.
- Malnutrition proxies and loss of residual kidney function are key determinants of hyponatremia.
- Associations between time-varying sodium levels and mortality can be U-shaped or inverse linear.
Conclusions:
- Hyponatremia is a significant concern in dialysis patients, linked to higher mortality through various potential mechanisms.
- Further research is crucial to elucidate causal pathways, optimal sodium targets, and the impact of interventions and sociodemographic factors.
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