Factors affecting prognosis of the patients with severe hyponatremia

Ercan Turkmen; Ahmet Karatas; Mahmut Altindal

doi:10.1016/j.nefro.2021.03.007

Factors affecting prognosis of the patients with severe hyponatremia

Nefrologia (Engl Ed). 2021 Jun 18:S0211-6995(21)00102-8. doi: 10.1016/j.nefro.2021.03.007. Online ahead of print.

[Article in English, Spanish]

Authors

Ercan Turkmen¹, Ahmet Karatas², Mahmut Altindal³

Affiliations

¹ Nephrology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. Electronic address: ercan.turkmen1907@gmail.com.
² Nephrology, Ordu University Faculty of Medicine, Ordu, Turkey.
³ Nephrology, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey.

PMID: 34154847
DOI: 10.1016/j.nefro.2021.03.007

Abstract

Introduction: Hyponatremia is one of the most common electrolyte abnormalities in clinical practice. Data regarding factors that have impact on mortality of severe hyponatremia and outcomes of its therapeutic management is insufficient. The present study aimed to examine the factors associated with mortality and the outcomes of treatment in patients with severe hyponatremia.

Materials and methods: Patients with serum Na≤115mequiv./L who were admitted to Ordu State Hospital and Ordu University Training and Research Hospital between 2014 and 2018 were included in the study. Demographic and laboratory features, severity of the symptoms, comorbid diseases, medications, and clinical outcome measures of the patients were obtained retrospectively from their medical records. Factors associated with in-hospital mortality, overcorrection and undercorrection were assessed.

Results: A total of 145 patients (median age 69 years and 58.6% female) met inclusion criteria. Diuretic use was the most common etiologic factor for severe hyponatremia that present in 50 (34.5%) patients. Sixty-seven (46.2%) patients had moderately severe while 8 patients (5.5%) had severe symptoms. The median increase in serum Na 24h after admission in the study population was 8.9mequiv./L (-6 to 19). Nonoptimal correction was seen in 92 (63.4%) patients. Hypertonic saline use was associated with overcorrection (OR, 3.07; 95% CI: 1.47-6.39; p=0.002). Avoidance of hypertonic saline (aOR, 2.52; 95% CI: 1.12-5.66; p=0.029) and having neuropsychiatric disorder (aOR, 2.60; 95% CI: 1.10-6.11; p=0.025) were associated with undercorrection. In-hospital mortality rate was 12.4% and having CKD and cancer, undercorrection of sodium and presence of severe symptoms were significantly associated with in-hospital mortality.

Conclusion: Severe hyponatremia in hospitalized patients is associated with substantial mortality. The incidence of non-optimal correction of serum Na is high; under-correction, presence of severe symptoms, chronic kidney disease and cancer were the factors that increase mortality rate.

Keywords: Chronic kidney disease; Corrección insuficiente; Enfermedad renal crónica; Hiponatremia severa; Malignancy; Malignidad; Mortalidad; Mortality; Severe hyponatremia; Undercorrection.