DOI: 10.1093/ckj/sfae419 ISSN: 2048-8505

Acute kidney injury with hypernatremia and major adverse kidney events

Jose J Zaragoza, Juan A Gómez-Fregoso, Eduardo M Hernández-Barajas, Zarahi Andrade-Jorge, Juarez Correa-de Leon, Rolando Claure-Del Granado, Jorge L Padilla-Armas, R Lizzete Ornelas-Ruvalcaba, J Said Cabrera-Aguilar, Gael Chávez-Alonso, Estefania Villalvazo-Maciel, Carlos E Orozco-Chan, Carlos B Cárdenas-Mercado, Gonzalo Rodríguez-García, Guillermo Navarro-Blackaller, Ramón Medina-González, Alejandro Martínez Gallardo-González, Luz Alcantar-Vallin, Gabriela J Abundis-Mora, Guillermo García-García, Jonathan S Chávez-Iñiguez

Abstract

Introduction

Consequences of hypernatremia in AKI (AKI-HyperNa) is poorly understood. We analyzed the risk of major adverse kidney events (MAKE) in comparison with AKI and normal serum sodium (AKI-normalNa). Such data could help in understanding this complex interaction.

Methods

In this retrospective cohort we compared the AKI-hyperNa with the AKI-normalNa regarding the risk of MAKE, which include death, new dialysis requirement, and worsening kidney function (≥ 25% decrease in eGFR), at 10 (MAKE10) and at 30–90 days (MAKE30–90) using multivariate logistic regression and area under the curve (AUC) analysis. Also the association between serum sodium levels (per 1 mEq/L increase) and the number of days with hypernatremia.

Results

A total of 357 patients were included (78 with AKI-hyperNa and 279 with AKI-normalNa). Compared to the AKI-normalNa, AKI-hyperNa were predominantly male (73% vs. 59%), experienced hypernatremia for a longer duration (3 days vs. 0 days), and took 5 days to normalize serum sodium levels. After multivariate regression analysis AKI-hyperNa group had higher risk of MAKE10 (OR 5.7, CI 2.5–12.89, p < 0.001) with an AUC of 0.79.

Also its components such as mortality and decreased eGFR (OR 2.13, CI 1.11–4.07, p = 0.021 and OR 20.14, CI 7.69–10.03, p = 0.001, respectively). A similar trend for MAKE30–90 (OR 4.17, CI 1.73–10.03, p ≤ 0.001).A gradual increase in serum sodium was associated with a higher risk of MAKE (OR 1.07, CI 1.04–1.11, p ≤ 0.001), as was the number of days spend with hypernatremia (OR 1.51, CI 1.22–1.87, p = 0.001).

Conclusions

In this cohort, AKI-hyperNa compared with AKI-normalNa, had a 5-fold risk of short- and long-term MAKE. This event was more frequently observed as serum sodium increased and it was closely related to the number of days that hypernatremia persisted.

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