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Original ArticlesAcid/Base and Electrolyte Disorders
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Trajectories of Serum Sodium on In-Hospital and 1-Year Survival among Hospitalized Patients

Api Chewcharat, Charat Thongprayoon, Wisit Cheungpasitporn, Michael A. Mao, Sorkko Thirunavukkarasu and Kianoush B. Kashani
CJASN May 2020, 15 (5) 600-607; DOI: https://doi.org/10.2215/CJN.12281019
Api Chewcharat
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota;
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Charat Thongprayoon
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota;
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Wisit Cheungpasitporn
2Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi;
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Michael A. Mao
3Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida; and
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Sorkko Thirunavukkarasu
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota;
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Kianoush B. Kashani
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota;
4Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota;
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Abstract

Background and objectives This study aimed to investigate the association between in-hospital trajectories of serum sodium and risk of in-hospital and 1-year mortality in patients in hospital.

Design, setting, participants, & measurements This is a single-center cohort study. All adult patients who were hospitalized from years 2011 through 2013 who had available admission serum sodium and at least three serum sodium measurements during hospitalization were included. The trend of serum sodium during hospitalization was analyzed using group-based trajectory modeling; the five main trajectories were grouped as follows: (1) stable normonatremia, (2) uncorrected hyponatremia, (3) borderline high serum sodium, (4) corrected hyponatremia, and (5) fluctuating serum sodium. The outcome of interest was in-hospital mortality and 1-year mortality. Stable normonatremia was used as the reference group for outcome comparison.

Results A total of 43,539 patients were analyzed. Of these, 47% had stable normonatremia, 15% had uncorrected hyponatremia, 31% had borderline high serum sodium, 3% had corrected hyponatremia, and 5% had fluctuating serum sodium trajectory. In adjusted analysis, there was a higher in-hospital mortality among those with uncorrected hyponatremia (odds ratio [OR], 1.33; 95% CI, 1.06 to 1.67), borderline high serum sodium (OR, 1.66; 95% CI, 1.38 to 2.00), corrected hyponatremia (OR, 1.50; 95% CI, 1.02 to 2.20), and fluctuating serum sodium (OR, 4.61; 95% CI, 3.61 to 5.88), compared with those with the normonatremia trajectory. One-year mortality was higher among those with uncorrected hyponatremia (hazard ratio [HR], 1.28; 95% CI, 1.19 to 1.38), borderline high serum sodium (HR, 1.18; 95% CI, 1.11 to 1.26), corrected hyponatremia (HR, 1.24; 95% CI, 1.08 to 1.42), and fluctuating serum sodium (HR, 2.10; 95% CI, 1.89 to 2.33) compared with those with the normonatremia trajectory.

Conclusions More than half of patients who had been hospitalized had an abnormal serum sodium trajectory during hospitalization. This study demonstrated that not only the absolute serum sodium levels but also their in-hospital trajectories were significantly associated with in-hospital and 1-year mortality. The highest in-hospital and 1-year mortality risk was associated with the fluctuating serum sodium trajectory.

Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_25_CJN.12281019.mp3

  • sodium
  • survival
  • hospitalized patients
  • hyponatremia
  • hypernatremia
  • hospital mortality
  • cohort studies
  • hospitalization
  • hospitals
  • Received October 10, 2019.
  • Accepted February 7, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (5)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 5
May 07, 2020
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Trajectories of Serum Sodium on In-Hospital and 1-Year Survival among Hospitalized Patients
Api Chewcharat, Charat Thongprayoon, Wisit Cheungpasitporn, Michael A. Mao, Sorkko Thirunavukkarasu, Kianoush B. Kashani
CJASN May 2020, 15 (5) 600-607; DOI: 10.2215/CJN.12281019

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Trajectories of Serum Sodium on In-Hospital and 1-Year Survival among Hospitalized Patients
Api Chewcharat, Charat Thongprayoon, Wisit Cheungpasitporn, Michael A. Mao, Sorkko Thirunavukkarasu, Kianoush B. Kashani
CJASN May 2020, 15 (5) 600-607; DOI: 10.2215/CJN.12281019
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