Impact of Hyponatremia after Renal Transplantation on Decline of Renal Function, Graft Loss and Patient Survival: A Prospective Cohort Study.

Lena Berchtold,Aurelia Schnyder,Dela Golshayan,Suzan Dahdal,Spyridon Arampatzis,Vasileios Devetzis,Marco Bonani,Sophie De Seigneux,On Behalf Of Swiss Transplant Cohort Study Collaborators ,Patrizia Amico,Uyen Huynh-Do,Anja Filzer,Rita Achermann

doi:10.3390/nu13092995

Abstract

Background: Hyponatremia is one of the most common electrolyte disorders observed in hospitalized and ambulatory patients. Hyponatremia is associated with increased falls, fractures, prolonged hospitalisation and mortality. The clinical importance of hyponatremia in the renal transplant field is not well established, so the aim of this study was to determine the relationships between hyponatremia and mortality as main outcome and renal function decline and graft loss as secondary outcome among a prospective cohort of renal transplant recipients. Methods: This prospective cohort study included 1315 patients between 1 May 2008 and 31 December 2014. Hyponatremia was defined as sodium concentration below 136 mmol/L at 6 months after transplantation. The main endpoint was mortality. A secondary composite endpoint was also defined as: rapid decline in renal function (≥5 mL/min/1.73 m2 drop of the eGFR/year), graft loss or mortality. Results: Mean sodium was 140 ± 3.08 mmol/L. 97 patients displayed hyponatremia with a mean of 132.9 ± 3.05 mmol/L. Hyponatremia at 6 months after transplantation was associated neither with mortality (HR: 1.02; p = 0.97, 95% CI: 0.47–2.19), nor with the composite outcome defined as rapid decline in renal function, graft loss or mortality (logrank test p = 0.9). Conclusions: Hyponatremia 6 months after transplantation is not associated with mortality in kidney allograft patients.

Highlights

Hyponatremia, classically defined as a serum sodium concentration of less than136 mmol/L, is one of the most common electrolyte disorders in hospitalized and ambulatory patients [1,2,3,4]
Our study aims at contributing prospective data regarding hyponatremia and adverse outcome in renal transplantation by determining the relationships between hyponatremia and mortality, and as secondary outcome renal function decline or graft loss among a cohort of renal transplanted patients within the Swiss Transplant Cohort Study (STCS)
From June 2008 to December 2014, a total of 1655 kidney transplantations were performed in the six Swiss centres participating in the STCS Study

Summary

Introduction

Hyponatremia, classically defined as a serum sodium concentration of less than136 mmol/L, is one of the most common electrolyte disorders in hospitalized and ambulatory patients [1,2,3,4]. The clinical importance of hyponatremia in the renal transplant field is not well established, so the aim of this study was to determine the relationships between hyponatremia and mortality as main outcome and renal function decline and graft loss as secondary outcome among a prospective cohort of renal transplant recipients. Hyponatremia was defined as sodium concentration below 136 mmol/L at 6 months after transplantation. A secondary composite endpoint was defined as: rapid decline in renal function (≥5 mL/min/1.73 m2 drop of the eGFR/year), graft loss or mortality. Hyponatremia at 6 months after transplantation was associated neither with mortality (HR: 1.02; p = 0.97, 95% CI: 0.47–2.19), nor with the composite outcome defined as rapid decline in renal function, graft loss or mortality (logrank test p = 0.9). Conclusions: Hyponatremia 6 months after transplantation is not associated with mortality in kidney allograft patients

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Conclusion