Hyponatremia in Chronic Kidney Disease

Abstract

Introduction: There is adequate literature written on hyponatremia, but not much seen in context of Chronic Kidney Disease (CKD). Patients become prone for this electrolyte derangement when they are afflicted with organ failure especially CKD. This vulnerability becomes even worse in ageing due to impaired sensitivity to fluid intake and often burdened with multiple comorbid. For the adequate management of hyponatremia, knowledge of volume status, age of patients and associated comorbid, and duration of hyponatremia are very important. Patients and Methods: This observational study was conducted in adult CKD admitted patients. Demographic information, history, and examination finding were noted. Then each patient underwent investigation i.e., serum sodium, urea, creatinine, spot urine sodium, chloride, potassium, urine and serum osmolality, random blood sugar and echocardiography and noted in questionnaire. CKD staging was done with the help of Modified of diet and Renal disease (MDRD) equation. Diagnosis/ Impression of patient and need of hypertonic saline (3%saline) were all noted along with final outcome whether sodium improved/unimproved, discharge/expired were noted in pre-formed questionnaire. Results: Analysis was done on 171 CKD patients with female to male ratio: 1.19/1 and mean age 55.8 ± 15.16. Hypertension was most prevalent comorbid. Hypovolemia was the most common volume status seen along with moderate hyponatremia and hypertonicity were frequently observed features. 23 out of 171 patients were symptomatic, 44(25.7%) had low Left Ventricular function. Mortality was noted at 9.4%. Conclusion: Overall outcome of patient remained satisfactory despite of presence of CKD and significant number of patients were severe hyponatremic. Predominant management for hyponatremia remained conservative along with treatment for primary disease. Symptomatic hyponatremia and low LV function were found to be contributing to bad outcomes while severity of hyponatremia did not influence badly.