Observational studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2016
Pre-dialysis serum sodium and mortality in a national incident hemodialysis cohort.
Observational study in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 62 citations in OpenAlex.
- Association of serum sodium and risk of all-cause mortality in patients with chronic kidney disease: A meta-analysis and sysematic review.Scientific reports · 2017Pooled it
- Association between serum chloride and mortality in patients on maintenance hemodialysis: the Osaka dialysis complication study (ODCS).Clinical and experimental nephrology · 2026Article
- Higher serum follistatin levels are associated with increased vascular calcification in haemodialysis patients.Frontiers in endocrinology · 2026Article
- Hyponatremia and the risk of sepsis in the setting of chronic kidney disease not on dialysis.Clinical kidney journal · 2025Article
- How to Limit Interdialytic Weight Gain in Patients on Maintenance Hemodialysis: State of the Art and Perspectives.Journal of clinical medicine · 2025Review
- Thiazide-Associated Hyponatremia and Mortality Risk: A Cohort Study.Kidney medicine · 2025Article
- Changes in serum sodium concentration during hemodialysis is a predictor of mortality and cardio-cerebrovascular event.Renal failure · 2024Article
- Article
- Association of serum sodium levels with fractures and mortality in patients undergoing maintenance hemodialysis.Journal of nephrology · 2024Article
- Clinical characteristics and outcomes of maintenance hemodialysis patients with COVID-19 during the Omicron wave of the pandemic in Beijing: a single center retrospective study.BMC nephrology · 2024Article
- Identification of independent risk factors for hypoalbuminemia in patients with CKD stages 3 and 4: the construction of a nomogram.Frontiers in nutrition · 2024Article
- Impact of an angulated aorto-septal relationship on cardio-cerebrovascular outcomes in patients undergoing hemodialysis.PloS one · 2024Article
- Practical implementation and clinical benefits of the new automated dialysate sodium control biosensor.Clinical kidney journal · 2023Article
- Article
- Dysnatremia and risk of bloodstream infection in dialysis patients.Clinical kidney journal · 2022Article
- The impact of chronic pre-dialysis hyponatremia on clinical outcomes in maintenance hemodialysis patients.International urology and nephrology · 2022Article
- Echocardiographic left ventricular hypertrophy and geometry in Chinese chronic hemodialysis patients: the prevalence and determinants.BMC cardiovascular disorders · 2022Observational
- Association of pre-ESKD hyponatremia with post-ESKD outcomes among incident ESKD patients.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2022Article
- Pre-dialysis Hyponatremia and Change in Serum Sodium Concentration During a Dialysis Session Are Significant Predictors of Mortality in Patients Undergoing Hemodialysis.Kidney international reports · 2021Article
- Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment.Frontiers in medicine · 2021Review
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundA consistent association between low serum sodium measured at a single-point-in-time (baseline sodium) and higher mortality has been observed in hemodialysis patients. We hypothesized that both low and high time-varying sodium levels (sodium levels updated at quarterly intervals as a proxy of short-term exposure) are independently associated with higher death risk in hemodialysis patients.
methodsWe examined the association of baseline and time-varying pre-dialysis serum sodium levels with all-cause mortality among adult incident hemodialysis patients receiving care from a large national dialysis organization during January 2007-December 2011. Hazard ratios were estimated using multivariable Cox models accounting for case-mix+laboratory covariates and incrementally adjusted for inter-dialytic weight gain, blood urea nitrogen and glucose.
resultsAmong 27 180 patients, a total of 7562 deaths were observed during 46 194 patient-years of follow-up. Median (IQR) at-risk time was 1.4 (0.6, 2.5) years. In baseline analyses adjusted for case-mix+laboratory results, sodium levels <138 mEq/L were associated with incrementally higher mortality risk, while the association of sodium levels ≥140 mEq/L with lower mortality reached statistical significance only for the highest level of pre-dialysis sodium (reference: 138-<140 mEq/L). In time-varying analyses, we observed a U-shaped association between sodium and mortality such that sodium levels <138 and ≥144 mEq/L were associated with higher mortality risk. Similar patterns were observed in models incrementally adjusted for inter-dialytic weight gain, blood urea nitrogen and glucose.
conclusionsWe observed a U-shaped association of time-varying pre-dialysis serum sodium and all-cause mortality in hemodialysis patients, suggesting that both hypo- and hypernatremia carry short-term risk in this population.
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