Lower Serum Sodium Combined with Lower Uric Acid Concentrations Associates with Worse Long-Term Clinical Outcomes in Hemodialysis Patients

BACKGROUND: The purpose of this study was to evaluate the combined effect of different prehemodialysis (HD) serum sodium (S[Na]) and uric acid (S[UA]) concentrations on long-term prognosis of HD patients. METHODS: A cohort of 424 maintenance HD patients (age: 58±13 years, male: 47%, diabetes: 39%) from a single center were divided into four groups based on both medians of S[Na] (138.4 mEq/L) and S[UA] (7.71 mg/dL). Group 1: lower S[Na] & lower S[UA]: N=111; Group 2: lower S[Na] & higher S[UA]: N=101; Group 3: higher S[Na] & lower S[UA]: N=101; Group 4: higher S[Na] & higher S[UA]: N=111. The maximum observation period was 60 months. RESULTS: Either lower S[Na] or lower S[UA] group had a worse cumulative survival than their higherlevel counterparts (P=0.02, and 0.03 respectively). By combination, Group 1 had higher long-term mortality rate than the other 3 groups. Lower S[Na] group had a significantly higher fl uid gain before HD than higher S[Na] group (2.8±0.8 vs. 2.6±0.6 L, P=0.008). After multivariate logistic regression analysis, Group 1 was characterized by high percentage of diabetes (OR=1.64, 95%CI=1.03~2.61), lower serum albumin level (OR=0.50, 95%CI=0.30~0.85) and female sex (OR=0.62, 95%CI=0.39~0.99). Adjusting for age, diabetes, serum albumin concentration, gender, and normalized protein catabolism rate, Group 1 was still an independent risk factor for long-term mortality (HR: 1.53; 95%CI: 1.02~2.30). CONCLUSION: HD patients with combined lower S[Na] and lower S[UA] were characterized by higher percentage of DM, and hypoalbuminemia. They were associated with higher long-term mortality rate. By contrast, those patients with higher levels of either S[Na] or S[UA] tended to have better clinical outcomes.

並列關鍵字

chronic kidney disease ； end-stage renal disease ； hyponatremia ； hypouricemia ； malnutrition

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