title: Hyponatremia is a surrogate marker of poor outcome in peritoneal dialysis-related peritonitis.
abstract: BACKGROUND
  Hyponatremia is known to be a marker of poor prognosis in many clinical conditions. The association between hyponatremia and clinical outcomes in peritoneal dialysis-related peritonitis (PDRP) has not been studied. We evaluated the association between hyponatremia and clinical parameters of patients with PDRP.
  
  
  METHODS
  We conducted a retrospective analysis of medical records of patients with PDRP admitted to a medical center in the period 2004-2011. Patients with serum Na+ <130 mEq/L and ≥ 130 mEq/L at admission were divided into hyponatremic and normonatremic groups, respectively. The demographic and laboratory characteristics, pathogens of peritonitis, length of hospital stay and mortality rate were analyzed.
  
  
  RESULTS
  Hyponatremia occurred in 27% (27/99) patients with PDRP. Gram-negative bacilli were the major pathogen responsible for 78% (21/27) PDRP in hyponatremic group while gram-positive cocci were found in 75% (41/55) PDRP in normonatremic groups. There was no significant difference in age, duration of dialysis, PD catheter removal rate and technique failure between two groups. Hyponatremic group had significantly higher serum CRP (p <0.001), lower serum albumin (p < 0.001) and phosphate (p < 0.05). Of note, serum Na+ level was positively correlated with serum albumin (p < 0.001), phosphate (p < 0.04) levels, and subjective global assessment (SGA) score (p < 0.001). Moreover, the length of hospital stay was longer and in-hospital mortality rate was higher in hyponatremic group (p < 0.001). Using a multivariable logistic regression, we showed that hyponatremia at admission is an independent predictor of in-hospital mortality (OR 76.89 95% CI 3.39-1741.67, p < 0.05) and long hospital stay (OR 5.37, 95% CI 1.58- 18.19, p < 0.05).
  
  
  CONCLUSIONS
  In uremic patients with PDRP, hyponatremia at admission associated with a high frequency of gram negative bacilli infection, low serum albumin and phosphate levels, low SGA score, and poor prognosis with long hospital stay and high mortality rate.
authors.forename: Min-Hua
authors.initials: MH
authors.lastname: Tseng
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Cheng
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Sung
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chou
authors.forename: Pauling
authors.initials: P
authors.lastname: Chu
authors.forename: Giien Shuen
authors.initials: GS
authors.lastname: Chen
authors.affiliation: Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan. l521116@gmail.com.
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood* / Q000175:diagnosis*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000639:trends; D010538:Peritonitis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers