• Sang-Woong Han, Anca Tilea, Brenda W Gillespie, Fredric O Finkelstein, Margaret A Kiser, George Eisele, Peter Kotanko, Nathan Levin, and Rajiv Saran.
• Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
• Am. J. Nephrol. 2015 Jan 1; 41 (3): 200-9.

BackgroundChronic kidney disease (CKD) patients are prone to both hypo- and hypernatremia. Little has been published on the epidemiology of hypo- and hypernatremia in ambulatory patients with non-dialysis CKD.MethodsData collected in two contemporaneous CKD cohort studies, the Renal Research Institute (RRI)-CKD study (n = 834) and the Study of Treatment of Renal Insufficiency: Data and Evaluation (STRIDE) (n = 1,348) were combined and analyzed to study the association between serum sodium (Na(+)) and clinical outcomes.ResultsBaseline estimated glomerular filtration rate (eGFR) and Na(+) were 26 ± 11 ml/min/1.73 m(2) and 140.2 ± 3.4 mEq/l, respectively. The prevalence of Na(+) ≤135 mEq/l and ≥144 mEq/l was 6 and 16%, respectively. Higher baseline Na(+) was significantly associated with male sex, older age, systolic blood pressure, BMI, serum albumin, presence of heart failure, and lower eGFR. The risk of end-stage renal disease (ESRD) was marginally significantly higher among patients with Na(+) ≤135 mEq/l, compared with 140< Na(+) <144 mEq/l (referent), in time-dependent models (adjusted hazard ratio, HR = 1.52, p = 0.06). Mortality risk was significantly greater at 135< Na(+) ≤140 mEq/l (adjusted HR = 1.68, p = 0.02) and Na(+) ≥144 mEq/l (adjusted HR = 2.01, p = 0.01).ConclusionCKD patients with Na(+) ≤135 mEq/l were at a higher risk for progression to ESRD, whereas both lower and higher Na(+) levels were associated with a higher risk of mortality. While caring for CKD patients, greater attention to serum sodium levels by clinicians is warranted and could potentially help improve patient outcomes.© 2015 S. Karger AG, Basel.

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