Abnormal Sodium Levels Up Bacteremia Risk in Dialysis Patients
Study reveals 2-fold higher incidence of bacteremia among dialysis patients with low and high serum sodium levels.
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NEW ORLEANS—Low and high serum sodium levels are associated with an increased incidence of bacteremia among dialysis patients, investigators reported at the American Society of Nephrology's Kidney Week 2017 meeting.
In a study of 823 dialysis patients from the national Biospecimen Research Grant Program, Connie M. Rhee, MD, MSc, of the University of California Irvine and colleagues found that patients who had a serum sodium level below 134 mEq/L or greater than or equal to 140 mEq/L had an approximately 2-fold higher incidence of bacteremia compared with those who had a serum sodium level in the range of 136 to less than 138 mEq/L (reference).
The overall cohort had a mean age of about 60 years and a mean serum sodium value of 138 mEq/L. Approximately 10% of the cohort had at least 1 bacteremia event during the follow-up period.
As for possible mechanisms underlying the greater likelihood of infection among patients with low sodium levels, the authors cited that impairment of IL-17 producing helper T cells that function in host immunity, as well as concomitant mucosal membrane and cellular edema leading to breakdown of microbial barrier function may be contributory. They also indicated that further studies are needed to elucidate pathways underlying the high sodium—bacteremia association.
“While we typically focus upon the central nervous system toxicity or skeletal complications of dysnatremia such as encephalopathy, disequilibrium, and fracture risk,” Dr Rhee told Renal & Urology News, “we hope that our study's findings highlight that immune dysfunction and infection may be adverse sequelae of this metabolic derangement.”
Further studies are needed to determine whether low and/or high sodium levels predispose to other types of infections that are commonly seen in dialysis patients, and whether correction of dysnatremia ameliorates infection risk.”
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Rhee CM, You AM, Streja E, et al. Serum sodium and bacteremia risk in dialysis patients. Data presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31-Nov. 5). Abstract TH-PO895.