title: Associations of dysnatremias with mortality in chronic kidney disease.
abstract: BACKGROUND
  Hyponatremia and hypernatremia are associated with death in the general population and those with chronic kidney disease (CKD). We studied the associations between dysnatremias, all-cause mortality and causes of death in a large cohort of Stage 3 and 4 CKD patients.
  
  
  METHODS
  We included 45 333 patients with Stage 3 and 4 CKDs followed in a large healthcare system. Associations between hyponatremia (<136 mmol/L) and hypernatremia (>145), and all-cause mortality and causes of death (cardiovascular, malignancy related and non-cardiovascular/non-malignancy related) were studied using Cox proportional hazards and competing risk models.
  
  
  RESULTS
  Dysnatremias were found in 9.2% of the study population. In separate multivariable Cox proportional hazards models using baseline serum sodium levels and time-dependent repeated measures, both hyponatremia and hypernatremia were associated with all-cause mortality. In the competing risk analyses, hyponatremia was significantly associated with increased risk for various cause-specific mortality categories [cardiovascular (hazard ratio, HR 1.16, 95% confidence interval, CI: 1.04, 1.30), malignancy related (HR 1.48, 95% CI: 1.33, 1.65) and non-cardiovascular/non-malignancy deaths (HR 1.25, 95% CI: 1.13, 1.39)], while hypernatremia was significantly associated with higher non-cardiovascular/non-malignancy mortality only (HR 1.36, 95% CI: 1.08, 1.72).
  
  
  CONCLUSIONS
  In those with CKD, hyponatremia was associated with all-cause mortality, cardiovascular, malignancy and non-cardiovascular/non-malignancy-related deaths. Hypernatremia was associated with all-cause and non-cardiovascular/non-malignancy-related deaths. Further studies are needed to elucidate the mechanisms of differences in cause-specific death among CKD patients with hyponatremia and hypernatremia.
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Geriatrics, Zhongda Hospital affiliated with Southeast University, Nanjing, China.
authors.forename: Haiquan
authors.initials: H
authors.lastname: Huang
authors.affiliation: Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Stacey E
authors.initials: SE
authors.lastname: Jolly
authors.affiliation: Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Medha
authors.initials: M
authors.lastname: Airy
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Nally
authors.affiliation: Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA.|Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000209:etiology / Q000401:mortality*; D007010:Hyponatremia / Q000097:blood / Q000209:etiology / Q000401:mortality*; D008297:Male; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D015996:Survival Rate
keywords: mortality and chronic kidney disease; sodium