Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure

Csaba Kovesdy, Evan H. Lott, Jun Ling Lu, Sandra M. Malakauskas, Jennie Z. Ma, Miklos Z. Molnar, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

148 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)677-684
Number of pages8
JournalCirculation
Volume125
Issue number5
DOIs
StatePublished - Feb 7 2012

Fingerprint

Hypernatremia
Hyponatremia
Chronic Renal Insufficiency
Heart Failure
Mortality
Sodium
Serum
Confidence Intervals
Veterans
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. / Kovesdy, Csaba; Lott, Evan H.; Lu, Jun Ling; Malakauskas, Sandra M.; Ma, Jennie Z.; Molnar, Miklos Z.; Kalantar-Zadeh, Kamyar.

In: Circulation, Vol. 125, No. 5, 07.02.2012, p. 677-684.

Research output: Contribution to journalArticle

Kovesdy, Csaba ; Lott, Evan H. ; Lu, Jun Ling ; Malakauskas, Sandra M. ; Ma, Jennie Z. ; Molnar, Miklos Z. ; Kalantar-Zadeh, Kamyar. / Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. In: Circulation. 2012 ; Vol. 125, No. 5. pp. 677-684.
@article{815ecc6a5c9546fbacac8cd7bb9941a1,
title = "Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure",
abstract = "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.",
author = "Csaba Kovesdy and Lott, {Evan H.} and Lu, {Jun Ling} and Malakauskas, {Sandra M.} and Ma, {Jennie Z.} and Molnar, {Miklos Z.} and Kamyar Kalantar-Zadeh",
year = "2012",
month = "2",
day = "7",
doi = "10.1161/CIRCULATIONAHA.111.065391",
language = "English (US)",
volume = "125",
pages = "677--684",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure

AU - Kovesdy, Csaba

AU - Lott, Evan H.

AU - Lu, Jun Ling

AU - Malakauskas, Sandra M.

AU - Ma, Jennie Z.

AU - Molnar, Miklos Z.

AU - Kalantar-Zadeh, Kamyar

PY - 2012/2/7

Y1 - 2012/2/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84862777295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862777295&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.111.065391

DO - 10.1161/CIRCULATIONAHA.111.065391

M3 - Article

VL - 125

SP - 677

EP - 684

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 5

ER -