摘要
目的调查院内急性肾损伤(acute kidney injury,AKI)患者住院期间血钠水平及血钠波动情况,并探讨其与院内死亡风险的相关性。方法该研究为单中心回顾性研究。纳入2018年1月1日至2020年12月31日于北京大学第一医院住院且至少行2次血钠检测的成年院内AKI患者为研究对象。血钠异常包括低钠血症(<135 mmol/L)和高钠血症(>145 mmol/L)。将患者分为低钠血症组、正常血钠组和高钠血症组,比较3组患者临床资料的差异。采用血钠变异系数评价住院期间血钠波动程度。采用限制性立方样条分析AKI发生时血钠水平与院内死亡的相关性,采用泊松回归分析探讨AKI发生时、入院时血钠异常以及血钠变异系数与院内死亡的相关性。结果共纳入院内AKI患者1475例,年龄66.0(55.0,78.0)岁,男性850例(57.6%),基线估算肾小球滤过率为77.3(50.4,97.6)ml·min-1·(1.73 m2)-1。AKI发生距离入院时间为8(4,15)d。入院时低钠血症及高钠血症发生率分别为19.6%(289/1475)和2.6%(39/1475),AKI发生时低钠血症及高钠血症发生率分别为24.0%(354/1475)和12.7%(188/1475)。低钠血症组、正常血钠组及高钠血症组年龄、AKI初始分级分布、心力衰竭比例、脑卒中比例、弥散性血管内凝血比例、脓毒症比例、急性呼吸窘迫综合征比例、休克比例、肾前性病因比例、袢利尿剂比例、醛固酮拮抗剂比例、入院时血钠、AKI发生时血钠、住院最低血钠、住院最高血钠及血钠变异系数的差异均有统计学意义(均P<0.05)。限制性立方样条分析结果显示,AKI发生时血钠水平与院内死亡呈“U”形相关性。泊松回归分析结果显示,在校正年龄、性别、慢性合并症数量、AKI初始分级、基线估算肾小球滤过率及急性疾病状态数量后,以正常血钠为参照,AKI发生时低钠血症(RR=1.56,95%CI 1.14~2.13)和高钠血症(RR=1.71,95%CI 1.23~2.39)均与院内死亡风险增加有关;入院时低钠血症与院内死亡风险增加相关(RR=2.13,95%CI 1.62~2.79),高钠血症与院内死亡风险无相关性(RR=1.22,95%CI 0.62~2.44)。进一步校正入院时及AKI发生时血钠水平后,血钠变异系数仍与院内死亡风险增加相关(RR=1.23,95%CI 1.14~1.33)。结论血钠异常在院内AKI患者中常见。AKI发生时血钠水平与院内死亡成“U”形相关性,血钠异常及血钠波动均与死亡风险增加相关。
Objective To investigate the serum sodium level and its fluctuation in patients with hospitalized acquired acute kidney injury(AKI)and explore their impacts on in-hospital mortality.Methods It was a single-center retrospective study.The adult patients developing hospital-acquired AKI and receiving at least twice serum sodium tests admitted to Peking University First Hospital from January 1,2018,to December 31,2020 were included.Dysnatremia included hyponatremia(<135 mmol/L)and hypernatremia(>145 mmol/L).The patients were divided into hyponatremia group,normal serum sodium group and hypernatremia group,and the differences of clinical data among the three groups were compared.The fluctuation of serum sodium level was evaluated by coefficient of variation.A restricted cubic spline was applied to investigate the association between serum sodium level at AKI onset and mortality.Poisson regression analysis was used to explore the mortality risk of dysnatremia at AKI onset,dysnatremia at admission,and coefficient of variation of serum sodium,respectively.Results Among the enrolled 1475 AKI patients,the age was 66.0(55.0,78.0)years,and 850 patients(57.6%)were males.The estimated glomerular filtration rate was 77.3(50.4,97.6)ml·min-1·(1.73 m2)-1.The time from admission to AKI onset was 8(4,15)days.The incidence of hyponatremia and hypernatremia at admission were 19.6%(289/1475)and 2.6%(39/1475),respectively,while the incidence at AKI onset was 24.0%(354/1475)and 12.7%(188/1475),respectively.There was statistically significant difference in terms of age,the initial classification distribution of AKI,serum sodium at admission,serum sodium at the occurrence of AKI,the lowest serum sodium at hospitalization,the highest serum sodium at hospitalization,the coefficient of variation of serum sodium,and the proportions of heart failure,stroke,disseminated intravascular coagulation,sepsis,acute respiratory distress syndrome,shock,prerenal causes,circle diuretics and aldosterone antagonists among hyponatremia group,normal serum sodium group and hypernatremia group(all P<0.05).The restricted cubic spline analysis showed a"U"-shaped correlation between serum sodium level at AKI onset and in-hospital mortality.Poisson regression analysis showed that after adjusting for age,gender,number of chronic comorbidities,initial classification of AKI,basal estimated glomerular filtration rate and number of acute disease state,with normal serum sodium as the reference,hyponatremia(RR=1.56,95%CI 1.14-2.13)and hypernatremia(RR=1.71,95%CI 1.23-2.39)at AKI onset were correlated with an increased risk of in-hospital mortality.Hyponatremia at admission was correlated with an increased risk of in-hospital mortality(RR=2.13,95%CI 1.62-2.79),while there was no statistically significant association between hypernatremia and in-hospital mortality(RR=1.22,95%CI 0.62-2.44).After further adjusting serum sodium levels at admission and at the occurrence of AKI,the coefficient of variation of serum sodium level was still correlated with an increased risk of in-hospital mortality(RR=1.23,95%CI 1.14-1.33).Conclusions Dysnatremia is common in patients with hospital-acquired AKI.The serum sodium level at AKI onset is correlated with in-hospital death in a"U"shape.Dysnatremia and serum sodium fluctuation are associated with an increased risk of in-hospital mortality.
作者
薛硕
徐菱忆
颜世悦
刘斯
唐灵儿
王晋伟
郑茜子
杨莉
Xue Shuo;Xu Lingyi;Yan Shiyue;Liu Si;Tang Linger;Wang Jinwei;Zheng Xizi;Yang Li(Emergency Department,Peking University First Hospital,Beijing 100034,China;Renal Division,Peking University First Hospital/Institute of Nephrology,Peking University/Key Laboratory of Renal Disease,Ministry of Health of China/Key Laboratory of Chronic Kidney Disease Prevention and Treatment,Ministry of Education of China/Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases,Chinese Academy of Medical Sciences,Beijing 100034,China)
出处
《中华肾脏病杂志》
北大核心
2025年第8期587-594,共8页
Chinese Journal of Nephrology
基金
北京市科技新星计划(2021051)
中央高校基本科研业务费(北京大学临床科学家计划,BMU2023PYJH023)
中央高水平医院临床科研业务费资助(北京大学第一医院青年临床研究专项,2022CR108)
北京大学第一医院院内交叉研究专项(2024IR14)。
关键词
高钠血症
低钠血症
急性肾损伤
死亡
Hypernatremia
Hyponatremia
Acute kidney injury
Mortality
