Osmotic stress and mortality in elderly patients with kidney failure: a retrospective study
Received 5 December 2017
Accepted for publication 18 April 2018
Published 30 January 2019 Volume 2019:14 Pages 225—229
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 3
Editor who approved publication: Dr Richard Walker
Caroline Grangeon-Chapon,1 Manuella Dodoi,2 Vincent LM Esnault,2,3 Guillaume Favre2,3
1Departments of Nuclear Medicine and Pharmacy, University Côte d’Azur, University Hospital of Nice, Nice, France; 2Department of Nephrology, University Côte d’Azur, University Hospital of Nice, Nice, France; 3Department of Nephrology, University Côte d’Azur, Institute for Research on Cancer and Aging of Nice (IRCAN), “Aging and Diabetes” Team, University Hospital of Nice, Nice, France
Purpose: Water balance disorders are associated with a high risk of death in elderly patients. The role of osmotic stress intensity and its direction toward hypo- or hypernatremia is a matter of controversy regarding patients’ survival. The aims of this study were, first, to measure the frequency of cellular hydration disorders in patients over 75 years old hospitalized in nephrology department for reversible acute renal failure, and second, to compare the impact of hyperhydration and hypohydration on the risk of death at 6 months.
Patients and methods: We retrospectively studied the data of 279 patients with chronic kidney disease (CKD), aged 75 years or older, with pre-renal azotemia who experienced dysnatremia. We classified them according to natremia levels and compared their outcome in univariate and multivariate analysis.
Results: The patients were on average 83.2±5.4 years old. Among them, 128 were normonatremic, 82 were hyponatremic and 69 were hypernatremic. Osmotic stress intensity appreciated by the variation rate of natremia did not differ significantly between hyper- and hyponatremic patients. Patients had CKD stage 3B and 4 with acute kidney injury (AKI) of different severities. We observed that only hypernatremia was linked to death in the first 6 months following hospital discharge.
Conclusion: Hypernatremia is a strong predictor of fatal outcome in elderly patients suffering from chronic kidney impairment and referred for pre-renal azotemia.
Keywords: acute kidney injury, aging, chronic kidney failure, hypernatremia, osmoregulation
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