ArticleEuropean journal of clinical nutrition2016
Unraveling the relationship between mortality, hyponatremia, inflammation and malnutrition in hemodialysis patients: results from the international MONDO initiative.
Article in European journal of clinical nutrition, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
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Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- Lean tissue mass is associated with adverse outcomes across different stages of chronic kidney disease: a systematic review and meta-analysis.Scientific reports · 2026Pooled it
- The efficacy of L-carnitine in improving malnutrition in patients on maintenance hemodialysis: a meta-analysis.Bioscience reports · 2020Pooled it
- Cost-effectiveness of bioimpedance-guided fluid management in patients undergoing haemodialysis: the BISTRO RCT.Health technology assessment (Winchester, England) · 2025Trial
- Article
- Analysis of biological systems using bioimpedance spectroscopy: a critical review of technological convergence and translational challenges.Frontiers in bioengineering and biotechnology · 2026Review
- Sodium Balance and Quality of Life in People with Chronic Kidney Disease-A Cross-Sectional Study.Nutrients · 2025Article
- Hyponatremia and the risk of sepsis in the setting of chronic kidney disease not on dialysis.Clinical kidney journal · 2025Article
- Nutrition risk stratification and metabolic disorders in patients on parenteral nutrition.Revista da Escola de Enfermagem da U S P · 2025Article
- Changes in serum sodium concentration during hemodialysis is a predictor of mortality and cardio-cerebrovascular event.Renal failure · 2024Article
- Hyponatremia and malnutrition: a comprehensive review.Irish journal of medical science · 2024Review
- Hypervolemia in Dialysis Patients Impairs STAT3 Signaling and Upregulates miR-142-3p: Effects on IL-10 and IL-6.International journal of molecular sciences · 2024Article
- Impact of an angulated aorto-septal relationship on cardio-cerebrovascular outcomes in patients undergoing hemodialysis.PloS one · 2024Article
- The Seattle Heart Failure Model in Kidney Transplant Recipients.Journal of clinical medicine · 2023Article
- Progress in the study of nutritional status and selenium in dialysis patients.Annals of medicine · 2023Review
- Relationship between serum sodium level at dialysis initiation and all-cause mortality.Clinical and experimental nephrology · 2023Article
- Assessment of a serum calcification propensity test for the prediction of all-cause mortality among hemodialysis patients.BMC nephrology · 2023Article
- The impact of chronic pre-dialysis hyponatremia on clinical outcomes in maintenance hemodialysis patients.International urology and nephrology · 2022Article
- Fluid Overload and Tissue Sodium Accumulation as Main Drivers of Protein Energy Malnutrition in Dialysis Patients.Nutrients · 2022Review
- Prediction of Heart Function and Volume Status in End-Stage Kidney Disease Patients through N-Terminal Pro-Brain Natriuretic Peptide.Medicina (Kaunas, Lithuania) · 2022Observational
- Humoral response to viral vector COVID-19 vaccine in hemodialysis patients.Kidney research and clinical practice · 2022Article
Corrections and comments
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Authors and funding
13 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
objectivesHyponatremia is a risk factor for mortality in hemodialysis (HD) patients. It is not well known to which extent the comorbidities, malnutrition, fluid status imbalance and inflammation are related to hyponatremia and affect outcomes. SUBJECTS/
methodsWe studied 8883 patients from the European subset of the international MONitoring Dialysis Outcomes initiative. Nutritional and fluid statuses were assessed by bioimpedance spectroscopy. Fluid depletion was defined as overhydration⩽-1.1 l and fluid overload as overhydration>+1.1 l, respectively. Malnutrition was defined as a lean tissue index below the 10th percentile of age- and gender-matched healthy controls. Hyponatremia and inflammation were defined as serum sodium levels <135 mEq/l and C-reactive protein levels>6.0 mg/l, respectively. We used logistic regression to test for predictors of hyponatremia and Cox proportional hazards analysis to assess the association with all-cause mortality.
resultsHyponatremia was predicted by the presence of malnutrition (odds ratio (OR)=1.49 (95% confidence interval (CI)=1.30-1.70), inflammation (OR=1.44 (95% CI=1.26-1.64)) and fluid overload ((>+1.1 l to +2.5 l) OR=0.73 (95% CI=0.62-0.85)) but not by fluid depletion (OR=1.34 (95% CI=0.92-1.96)). Malnutrition, inflammation, fluid overload, fluid depletion and hyponatremia (hazard ratio=1.70 (95% CI=1.46-1.99)) were independent predictors for all-cause mortality.
conclusionsIn HD patients, hyponatremia is associated with malnutrition, inflammation and fluid overload. Hyponatremia maintained predictive for all-cause mortality after adjustment for malnutrition, inflammation and fluid status abnormalities. The presence of hyponatremia may assist in identifying HD patients at increased risk of death.
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