Clinical research studyMortality Associated with Low Serum Sodium Concentration in Maintenance Hemodialysis
Section snippets
Study Population
This protocol was deemed exempt by the Partners Health Care Institutional Review Board. We performed a nonconcurrent cohort study of participants in the HEMO Study, the details of which have been previously published.4, 5, 6 Briefly, HEMO was a 2 × 2 factorial randomized control trial in which participants were assigned 1:1 to 1 of 2 levels of each dialysis dose and membrane flux (n = 1846). All participants were between 18 and 80 years old at study entry and had been receiving thrice weekly
Results
The primary cohort consisted of 1549 individuals. Overall, the mean (SD) age was 57.7 (14.2) years; 57% of participants were women; 64.2% were black. At baseline, mean (SD), median (interquartile range), minimum, and maximum predialysis serum sodium concentrations were 138.2 (4.0), 138 (136-141), 115, and 154 mEq/L, respectively (Figure 1). Over the course of the study, the median number of serum sodium measurements per subject was 5 (interquartile range 3-8). Considered over time, the overall
Discussion
The primary finding of this study is that among oligoanuric individuals on maintenance hemodialysis, lower serum sodium concentrations were associated with a greater risk of mortality. This association remained statistically significant upon adjustment for a number of demographic factors, comorbid disease, and laboratory measures that might plausibly confound the observed association. The association did not differ according to ultrafiltration volume or in those with or without congestive heart
Acknowledgment
The authors wish to thank the HEMO Study investigators and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) data repository for the data used in this study. The HEMO Study was performed by the HEMO Study investigators and supported by the NIDDK. This manuscript was not prepared in collaboration with the investigators of the HEMO Study and does not necessarily reflect the opinions or views of the HEMO Study or the NIDDK.
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Funding: Norman S. Coplon Extramural Grant Program, Satellite Healthcare (investigator-initiated grant). Satellite Healthcare had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript. SSW is supported by DK075941; SMB is supported by DK079056.
Conflict of Interest: Waikar and Curhan received grant support from Astellas for an investigator-initiated study of hyponatremia. Waikar participated in an advisory board meeting for Otsuka.
Authorship: All authors had access to the data and a role in writing the manuscript.