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Body Composition and Biochemical Factors Associated With Hyponatremia in Elderly Hemodialysis Patients

摘要


BACKGROUND: To investigate the prevalence of hyponatremia in elderly (≥ 65 years old) hemodialysis (HD) patients. Factors associated with chronic hyponatremia including demographic and biochemical data were collected. We aimed to identify the underlying causes relevant to chronic hyponatremia in these patients. METHODS: Among 966 chronic HD, 476 uremic patients were age ≥ 65 years old and 122 of these elderly patients were enrolled for further analysis. Their clinical data were reviewed and pre-dialysis laboratory data were collected. Body composition was measured by using of multifrequency bioimpedance spectroscopy device 30 minutes prior to midweek HD session. The patients were then divided into three groups according to the frequency of hyponatremia. RESULTS: Overall 17.9% of HD patients had mean sodium level < 134 mEq/L. The mean sodium (135.2 ± 3.4 mEq/L) of elderly HD patients (n = 476, 49.3%) was significantly lower than that of nonelderly patients (136.0 ± 3.4 mEq/L) and the prevalence of chronic hyponatremia was also higher (22.3 vs. 13.7%, P < 0.001). Regarding the frequency of hyponatremia, less than half of the elderly patients (48.9%) had persistent normal sodium levels whereas 64.1% of non-elderly patients were normonatremic continuously (P = 0.01). In elderly anuric patients who received body composition measurement, pre-dialysis serum creatinine, phosphorus, uric acid and albumin of chronic hyponatremia patients were significantly lower than normonatremic patients. The proportion of cardiothoracic ratios (CTR) greater than 0.5 was significantly higher (82.8 vs. 31.3%, P < 0.05). No significant difference of fluid status or other body composition parameters was noted in body composition test. In multivariate study, persistent hyponatremia was positively correlated with CTR > 0.5 but inversely associated with albumin. CONCLUSION: Hyponatremia was very common in elderly HD patients. No fluid excess or deficit were noted in patients with hyponatremia as noted in body composition measurement. Both serum albumin and CTR were significantly independent associates of chronic hyponatremia in elderly anuric HD patients.

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