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Epidemiology of Hyponatremia

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Title: Epidemiology of Hyponatremia


1
Epidemiology of Hyponatremia
  • Nicolaos E. Madias, M.D.
  • Chairman, Department of Medicine
  • Caritas St. Elizabeths Medical Center
  • Maurice S. Segal, M.D. Professor of
    Medicine
  • Tufts University School of Medicine

2
Hyponatremia
  • A decrease in serum sodium concentration to lt 136
    mmol/l

3
Determinants of the Frequency of Hyponatremia in
Clinical Studies
  • Serum sodium level
  • Frequency of testing
  • Health-care setting
  • Patient population/clinical setting
  • Other qualifiers (e.g., admission vs.
    hospital-acquired)

4
Epidemiology of Hyponatremia (lt130 mmol/l) in a
General Hospital
  • Daily incidence and prevalence of 1 and 2.5,
    respectively
  • 67 of all hyponatremia was hospital-acquired
  • Mean minimal Na was 125 mmol/l and values lt120
    mmol/l were observed in 12 of the hyponatremic
    patients

Anderson et al. Ann Intern Med. 1985102164-168.
5
Epidemiology of Hyponatremia (lt130 mmol/l) in a
General Hospital
N 196
Anderson et al. Ann Intern Med. 1985102164-168.
6
Postoperative Hyponatremia (lt130 mmol/l) in a
General Hospital
  • Developed in 4.4 of 1,088 prospectively studied
    patients
  • Frequency of hyponatremia varied according to
    type of surgery renal Tx, 92 cardiovascular,
    23 GI-biliary, 19 orthopedic, 3
    miscellaneous, 0.9
  • Mean minimal Na ranged from 125 to 128 mmol/l
    in various groups

Chung et al. Arch Intern Med. 1986146333-336.
7
Postoperative Hyponatremia (lt130 mmol/l) in a
General Hospital
N 48
Chung et al. Arch Intern Med. 1986146333-336.
8
Prevalence of Hyponatremia in a General Hospital
Aberdeen Royal Infirmary, n 33,467
Croal et al. Lancet. 19973501402.
9
Frequency of Hyponatremia in a General Hospital
Erasmus Medical Center, Rotterdam, Netherlands.
Data from a three-month prospective study in all
hospitalized patients (n2,907).
Hoorn et al. Nephrol Dial Transplant 20062170-6
10
Prevalence of Hyponatremia at Initial
Presentation to a Health Care Provider
Tan Tock Seng Hospital, Singapore. Data from
303,577 samples on 120,137 patients available for
analysis
Hawkins. Clin Chim Acta 2003337169-172.
11
Total, Admission, and Hospital-Acquired
Hyponatremia in Acute Hospital Care
Hawkins. Clin Chim Acta 2003337169-172.
12
Increasing Age is a Risk Factor for Hyponatremia
(lt 136 mmol/l) in Acute Hospital Care










Analysis adjusted for gender.
Hawkins. Clin Chim Acta 2003337169-172.
13
Increasing Age is a Risk Factor for Hyponatremia
(lt 116 mmol/l) in Acute Hospital Care








Analysis adjusted for gender
Hawkins. Clin Chim Acta 2003337169-172.
14
Male Gender is a Risk Factor for Hyponatremia in
Acute Hospital Care
Analysis adjusted for age
Hawkins. Clin Chim Acta 2003337169-172
15
Frequency of Hyponatremia (?135 mmol/l) in a
Nursing Home Population
  • Most recent serum Na during the past 12 months
  • VA nursing home residents (60-103 years old CNS
    disorders, 82 CVD, 60 DM, 21) 18 (21/119)
  • Geriatric ambulatory patients (62-91 years old)
    8 (5/60)
  • Lowest serum Na during the past 12 months
  • Nursing home residents 53 (63/119)
  • Abnormal water loading in hyponatremic nursing
    home patients 78 (18/23)

Miller et al. J Am Geriatr Soc. 1995431410-1413.
16
Validity of ICD-9 Code (276.1) for Detection of
Hyponatremia
ICD-9 codes reviewed on 2,632 cases of
hyponatremia identified on the basis of
laboratory data over a 22-month period
Movig et al J Clin Epidemiol 20036530-535
17
Admissions to an Acute Care Hospital that Had
Serum Sodium Measured on Day 1
CSEMC Database, Year 2001. (N 11,042
Admissions)
Sosa et al. J Am Soc Nephrol 200516862A.
18
Hyponatremia in an Acute Care Hospital
CSEMC Database, Year 2001. (N 11,042
Admissions)
Sosa et al. J Am Soc Nephrol 200516862A.
19
Occurrence of Hyponatremia in an Acute Care
Hospital According to Clinical Service
CSEMC Database, Year 2001. (N 11,042
Admissions)
Sosa et al. J Am Soc Nephrol 200516862A.
20
Hyponatremia on the Medical Service in an Acute
Care Hospital
CSEMC Database, Year 2001. (N 11,042
Admissions)
Sosa et al. J Am Soc Nephrol 200516862A.
21
Occurrence of Hyponatremia in Patients with Heart
Failure Admitted to an Acute Care Hospital
CSEMC Database, Year 2001. (N 11,042
Admissions)
Sosa et al. J Am Soc Nephrol 200516862A.
22
Hyponatremia ( 134 mmol/l) in Patients Admitted
with Severe Heart Failure
  • ESCAPE trial, 400 patients
  • Admission hyponatremia, 21
  • Hospital-acquired, 16

Gheorgiade et al. 54th Annual Scientific Session,
American College of Cardiology,1075-149. Year?
23
Hyponatremia in Patients with Chronic Liver
Disease Admitted to an Acute Care Hospital
CSEMC Database, Year 2001. (N 366 Admissions)
Sosa et al. J Am Soc Nephrol 200516862A
24
Hyponatremia (lt130 mmol/l) in Patients Admitted
with Complications of Cirrhosis
  • Present in 35 of 155 prospectively studied
    patients (all had ascites)1
  • Present in 30 of 191 prospectively studied
    patients (97 had ascites).
  • By contrast, it was present in 13.5 of 134
    cirrhotic patients followed in the outpatient
    clinic (plt0.001)2

1. Porcel et al. Arch Intern Med.
2002162323-328 2. Borroni et al. Digest Liver
Dis. 200032606-610.
25
Hyponatremia on the Surgical Service in an Acute
Care Hospital
CSEMC Database, Year 2001. (N 366 Admissions)
Sosa et al. J Am Soc Nephrol 200516862A
26
Hyponatremia in Endurance Exercise
  • Prospective analysis of 488 runners in the 2002
    Boston Marathon1
  • 13 developed hyponatremia ( 135 mmol/l)
  • 0.6 developed severe hyponatremia ( 120 mmol/l)
  • Prospective analysis of 605 participants in the
    New Zealand Ironman Triathlon2
  • 18 developed hyponatremia (lt 135 mmol/l)

1. Almond et al. N Eng J Med 20053521550-1556
2. Speedy et al. Med Sci Sports Exerc 1999
31809-815.
27
Mortality Rates in Normonatremic and Hyponatremic
Patients
(n 1,330)3
(n 397)1
(n 153)1
(n 169)2
1. Flear, 2. Westwater, 3. Samadi (need citations)
28
Discharge Hyponatremia is Associated with Adverse
Outcomes in Patients with Decompensated Heart
Failure
ESCAPE Trial (n 318)
P 0.003

Gheorghiade M et al. JACC 200545 (Suppl.
1)145A.
29
Hyponatremia is an Independent Risk Factor for
Hospital Death
4,123 patients age 65 years admitted to a
community hospital. Hyponatremia was associated
with a 2.2 higher relative risk of death after
adjustment for gender, age, diagnosis, length of
stay, history of surgery or a procedure, and
number of diagnoses.
Terzian et al J Gen Int Med 1994989-91
30
Association of Community-Acquired Hyponatremia
with Hospital Mortality
44,081 consecutive admissions multivariate
analysis adjusted for age, sex, race, admission
service type, and Deyo-Charlson comorbidity score
Wald et al J Am Soc Nephrol 2006 Abstract.
31
Association of Hospital-Aggravated Hyponatremia
(HAH) with Hospital Mortality
44,081 consecutive admissions multivariate
analysis adjusted for age, sex, race, admission
service type, and Deyo-Charlson comorbidity score
Wald et al J Am Soc Nephrol 2006 Abstract.
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