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Abstract: PO1143

The Prognostic Importance of Serum Sodium for Mortality Among Critically Ill Patients Requiring Continuous Renal Replacement Therapy

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Shawwa, Khaled, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Serum sodium derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum sodium (normal range 138-142 mmol/L) before and during CRRT with mortality.

Methods

This is a historical cohort study of 1,520 critically ill patients who received CRRT for at least 24 hours from December 2006 through November 2015 in a tertiary hospital in the United States. Using logistic regression analysis, we used serum sodium before CRRT, mean serum sodium, and serum sodium changes during CRRT to predict 90-day mortality after CRRT initiation.

Results

Compared with the normal serum sodium levels, the odds ratio (OR) of 90-day mortality in patients with serum sodium before CRRT of 143-147 and >148 mmol/L were 1.45 (95% CI 1.03-2.05), 2.24 (95% CI 1.33-3.87), respectively. There was no significant increase in 90-day mortality in serum sodium of <137 mmol/L. During CRRT, the mean serum sodium levels of ≤137 (OR 1.41; 95% CI 1.01-1.98) and ≥143 mmol/L (OR 1.52; 95% CI 1.14-2.03) were associated with higher 90-day mortality. The greater serum sodium changes during CRRT were associated with higher 90-mortality (OR 1.35; 95% CI 1.21-1.51 per 5-mmol/L increase).

Conclusion

Before CRRT initiation, hypernatremia and during CRRT, hypo-, and hypernatremia were associated with increased mortality.

Restricted cubic spline of the association between serum sodium before CRRT and 90-day mortality

Restricted cubic spline of the association between mean serum sodium during CRRT and 90-day mortality