Serum sodium and mortality in a national peritoneal dialysis cohort

Vanessa A. Ravel, Elani Streja, Rajnish Mehrotra, John J. Sim, Kevin Harley, Juan Carlos Ayus, Alpesh N. Amin, Steven M. Brunelli, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Connie M. Rhee

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo- and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients. Methods: We sought to examine the association of serum sodium over time and mortality among 4687 adult incident PD patients from a large US dialysis organization who underwent one or more serum sodium measurements within the first 3 months of dialysis over January 2007 to December 2011. We examined the association of time-dependent and baseline sodium with allcause mortality as a proxy of short- and long-term sodium-mortality associations, respectively. Hazard ratios were estimated using Cox models with three adjustment levels: minimally adjusted, case-mix adjusted, and case-mix + laboratory adjusted. Results: In time-dependent analyses, sodium levels <140 mEq/L were associated with incrementally higher death risk in casemix models (ref: 140 to <142 mEq/L); following laboratory covariate adjustment, associations between lower sodium and higher mortality remained significant for levels <136 mEq/L. In analyses using baseline values, sodium levels <140 mEq/L were associated with higher mortality risk across all models (ref: 140 to <142 mEq/L). Conclusions: In PD patients, lower time-dependent and baseline sodium levels were independently associated with higher death risk. Further studies are needed to determine whether correction of dysnatremia improves longevity in this population.

Original languageEnglish (US)
Pages (from-to)1224-1233
Number of pages10
JournalNephrology Dialysis Transplantation
Volume32
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Peritoneal Dialysis
Sodium
Mortality
Serum
Diagnosis-Related Groups
Dialysis
Hypernatremia
Hyponatremia
Proxy
Proportional Hazards Models
Sample Size
Population
Organizations

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Ravel, V. A., Streja, E., Mehrotra, R., Sim, J. J., Harley, K., Ayus, J. C., ... Rhee, C. M. (2017). Serum sodium and mortality in a national peritoneal dialysis cohort. Nephrology Dialysis Transplantation, 32(7), 1224-1233. https://doi.org/10.1093/ndt/gfw254

Serum sodium and mortality in a national peritoneal dialysis cohort. / Ravel, Vanessa A.; Streja, Elani; Mehrotra, Rajnish; Sim, John J.; Harley, Kevin; Ayus, Juan Carlos; Amin, Alpesh N.; Brunelli, Steven M.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Rhee, Connie M.

In: Nephrology Dialysis Transplantation, Vol. 32, No. 7, 01.07.2017, p. 1224-1233.

Research output: Contribution to journalArticle

Ravel, VA, Streja, E, Mehrotra, R, Sim, JJ, Harley, K, Ayus, JC, Amin, AN, Brunelli, SM, Kovesdy, C, Kalantar-Zadeh, K & Rhee, CM 2017, 'Serum sodium and mortality in a national peritoneal dialysis cohort', Nephrology Dialysis Transplantation, vol. 32, no. 7, pp. 1224-1233. https://doi.org/10.1093/ndt/gfw254
Ravel VA, Streja E, Mehrotra R, Sim JJ, Harley K, Ayus JC et al. Serum sodium and mortality in a national peritoneal dialysis cohort. Nephrology Dialysis Transplantation. 2017 Jul 1;32(7):1224-1233. https://doi.org/10.1093/ndt/gfw254
Ravel, Vanessa A. ; Streja, Elani ; Mehrotra, Rajnish ; Sim, John J. ; Harley, Kevin ; Ayus, Juan Carlos ; Amin, Alpesh N. ; Brunelli, Steven M. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar ; Rhee, Connie M. / Serum sodium and mortality in a national peritoneal dialysis cohort. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. 7. pp. 1224-1233.
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AU - Streja, Elani

AU - Mehrotra, Rajnish

AU - Sim, John J.

AU - Harley, Kevin

AU - Ayus, Juan Carlos

AU - Amin, Alpesh N.

AU - Brunelli, Steven M.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

AU - Rhee, Connie M.

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N2 - Background: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo- and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients. Methods: We sought to examine the association of serum sodium over time and mortality among 4687 adult incident PD patients from a large US dialysis organization who underwent one or more serum sodium measurements within the first 3 months of dialysis over January 2007 to December 2011. We examined the association of time-dependent and baseline sodium with allcause mortality as a proxy of short- and long-term sodium-mortality associations, respectively. Hazard ratios were estimated using Cox models with three adjustment levels: minimally adjusted, case-mix adjusted, and case-mix + laboratory adjusted. Results: In time-dependent analyses, sodium levels <140 mEq/L were associated with incrementally higher death risk in casemix models (ref: 140 to <142 mEq/L); following laboratory covariate adjustment, associations between lower sodium and higher mortality remained significant for levels <136 mEq/L. In analyses using baseline values, sodium levels <140 mEq/L were associated with higher mortality risk across all models (ref: 140 to <142 mEq/L). Conclusions: In PD patients, lower time-dependent and baseline sodium levels were independently associated with higher death risk. Further studies are needed to determine whether correction of dysnatremia improves longevity in this population.

AB - Background: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo- and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients. Methods: We sought to examine the association of serum sodium over time and mortality among 4687 adult incident PD patients from a large US dialysis organization who underwent one or more serum sodium measurements within the first 3 months of dialysis over January 2007 to December 2011. We examined the association of time-dependent and baseline sodium with allcause mortality as a proxy of short- and long-term sodium-mortality associations, respectively. Hazard ratios were estimated using Cox models with three adjustment levels: minimally adjusted, case-mix adjusted, and case-mix + laboratory adjusted. Results: In time-dependent analyses, sodium levels <140 mEq/L were associated with incrementally higher death risk in casemix models (ref: 140 to <142 mEq/L); following laboratory covariate adjustment, associations between lower sodium and higher mortality remained significant for levels <136 mEq/L. In analyses using baseline values, sodium levels <140 mEq/L were associated with higher mortality risk across all models (ref: 140 to <142 mEq/L). Conclusions: In PD patients, lower time-dependent and baseline sodium levels were independently associated with higher death risk. Further studies are needed to determine whether correction of dysnatremia improves longevity in this population.

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