Cardiorenal Syndrome in Hospitalized Patients with ...

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Martin-Luther-University Halle-Wittenberg, Clinic of Internal Medicine II, Nephrology, Halle (Saale), Germany presented at Renal Week, Annual Meeting of the ...

Cardiorenal Syndrome in Hospitalized Patients with Mild versus Moderate- to- Severe Concomitant Hyponatremia on Admission: A Retrospective Study R. U. Pliquett1, K. I. Schlump1, M. Girndt1 1. Martin-Luther-University Halle-Wittenberg, Clinic of Internal Medicine II, Nephrology, Halle (Saale), Germany presented at Renal Week, Annual Meeting of the American Society of Nephrology, Atlanta, 2013.

Background

Results - 1 -

Results - 2 -

• Hyponatremia has been related to a worse outcome among hospitalized patients with different Co-morbidities including chronic heart failure. Regarding cardiorenal syndrome (CRS), a detrimental role for hyponatremia has been extrapolated from chronic heart failure studies (CJASN 2009;4:2013). However, so far, very little data derived from actual CRS patients. • Here, the degree of (acute) renal failure, (acute) cardiac failure on admission, duration of hospital stay, and 1-year mortality were determined for hospitalized CRS patients with mild or moderate-to-severe hyponatremia on admission.

• Over a 5-year period, 386 patients with CRS diagnosis were identified using hospital software. Diagnosis was checked and confirmed in 262 patients (123 males) entering this retrospective study. Hyponatremia on admission was present in 90 or 34.4% of hospitalized CRS patients: mild hyponatremia in 59 (22.5%), moderate hyponatremia in 22 (8.4%), severe hyponatremia in 9 (3.4%) patients (Figure 1).

• Creatinine on admission was not different between groups (mild hyponatremia: Crea=256 µmol/l, CI 255.7 – 370.2; moderate-severe hyponatremia: Crea=226 µmol/l, CI: 212.1 – 342.6).

• Except for spironolactone, the use of diuretics was not different among CRS patients with and without hyponatremia on admission (Figure 2). • BNP on admission tended to be higher in CRS patients with mild hyponatremia (754.5 pg/ml, CI: 799.5 - 2106) versus moderate-severe hyponatremia (491.5 pg/ml, CI: 300.2 - 1934; p=0.07).

• CRS Index was significantly (p 1), the closest birth date.

50.0%

m ol /l

0

Months after admission (index hospitalization)

600000.0

13 0, N a< 13 5

500

78.8%

Thiazide

a≥ m m 12 ol 5, /l N a< 13 N 0 a≥ m m 13 ol 0, /l N a< 13 5 m m ol /l

N a≥ 13 5

m m ol /l

,N a< 13 5

1000

*

ol /l

78.8%

90.9%

1500

800000.0

m m

Loop diuretic

83.3%

0.0

0

Diuretic (one or more)

Controls

BNP (pg/ml) x Crea (µmol/l)

Cases

BNP (pg/ml)

- Duration of hospitalization and 1-year mortality (city-council inquiry) was determined.

p=0.07

2000

200000.0

CRS index (BNP x Crea) in CRS with mild vs. moderate-severe hyponatremia

BNP in CRS with mild vs. moderate-severe hyponatremia

- Laboratory values were gathered on admission: serum sodium, creatinine (Crea), brain-natriuretic peptide (BNP) and the product thereof (CRS index = Crea x BNP).

400000.0

N

N a≥ 12 5

Figure 1: Baseline characteristics.

m m ol /l

m m ol /l

0

600000.0

N a< 13

75 years 74,5 years 82 57 90 33

800000.0

Cumulative Survival

1000

1000000.0

N a≥ 13 5

BNP (pg/ml) x Crea (µmol/l)

1500

N a< 12 5

Age female male

2000

N a≥ 13 0

Na on admission 139 mol/l 131 mmol/l

2500

,N a< 13 0

Na ≥ 135 Na < 135 mmol/l mmol/l (n= 172) (n= 90)

Survival in CRS patients with,without hyponatremia

CRS index (BNP x Crea) in CRS patients w/wo hyponatremia

BNP in CRS patients w/wo hyponatremia

BNP (pg/ml)

- Retrospective study of consecutive CRS patients (Clinic of Internal Medicine II, University Hospital of the Martin-Luther University Halle-Wittenberg) admitted between 10/01/2007 and 12/31/2011. Diagnosis group-related information (presence of disease codes N18.x and I50.x) was used to identify CRS patients using hospital software. Diagnosis was verified using individual patient records. CRS patients were grouped according to serum sodium on admission into CRS with mild (

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