In hospitalized patients with end-stage kidney disease, the presence vs absence of hypernatremia or hyponatremia (ESKD) is associated with higher in-hospital mortality and longer hospital length of stay (LOS), investigators concluded in a poster presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts.

After adjusting for age, sex, race, and comorbidities, hypernatremia and hyponatremia were significantly associated with a 2.0- and 1.8-fold increased odds for in-hospital death compared with patients without these conditions, Calvin Ghimire, MD, of McLaren Flint Hospital in Flint, Michigan, and colleagues reported. Female patients had significantly lower in-hospital mortality and shorter LOS compared with male patients.

Patients with hypernatremia and hyponatremia had a significantly longer LOS than patients without these conditions (11.6 vs 5.7 days and 8.9 vs 5.4 days, respectively).

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The findings are from a study of 643,555 index hospitalizations for ESKD identified in the National Inpatient Sample. The racial composition was 39.2% White and 34.9% Black. The study population was 54.7% male and 45.3% female. The mean patient age was 61.6 years.

Patients with vs without hypernatremia were significantly older (66.5 vs 61.5 years) and significantly more likely to be Black (38.1% vs 34.8%).

Patients with vs without hyponatremia were significantly older (63 vs 61 years), significantly more likely to be female (49.1% vs 44.8%), and significantly less likely to be Black (27.2% vs 35.9%).

“Prevention of dysnatremia remains vital and patient education remains a cornerstone to achieve it,” Dr Ghimire’s team wrote.

They also observed, “Effectiveness of managing underlying comorbidities and renal replacement methods to maintain normal sodium level as per the requirement remains an unsolved mystery to prevent worse clinical outcomes and mortality.”


Ghimire C, Baral N, Kambalapalli S, Seri AR, Mathew SM, Kunadi A. Outcomes of sodium imbalances in patients primarily hospitalized for end stage renal disease. Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022. Poster 214.