Dysnatremias among ambulatory patients with chronic kidney disease (CKD) are associated with end-stage kidney disease (ESKD) and death, investigators confirm.

Among 5444 patients with nondialysis-dependent CKD (aged 21-74 years) in the Chronic Renal Insufficiency Cohort (CRIC) study, 8.9% had hyponatremia (serum sodium less than 136 mmol/L) and 0.9% had hypernatremia (serum sodium 145 mmol/L or more).

In adjusted Cox models, the risks for all-cause mortality were a significant 38% and 54% higher among patients with time-dependent hyponatremia and hypernatremia, respectively, compared with eunatremia, Jonathan J. Taliercio, DO, of Glickman Urological and Kidney Institute, Cleveland, Ohio, and colleagues reported in Kidney Medicine.

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The risks for ESKD were a significant 64% higher with time-dependent hypernatremia vs eunatremia, the investigators reported. In patients younger than 65 years only, baseline and time-dependent hyponatremia were significantly associated with a 30% and 36% increased risk of kidney failure, respectively.

The investigators found that hyponatremia occurred more often in female patients with diabetes, hypertension, or congestive heart failure who used thiazide diuretics. Black patients had lower risks for hyponatremia.

“Treating physicians should recognize the potential risks of dysnatremias in patients with CKD in the hopes of potentially improving outcomes,” Dr Taliercio’s team wrote. “More clarity is required to better understand the association between dysnatremias, mortality, and kidney failure, and if correction can improve outcomes.”

Strengths of the CRIC study include its large, diverse population of patients with CKD, long follow-up, and defined cardiac and kidney outcomes. However, results cannot be generalized to hospitalized patients or those with cirrhosis, New York Heart Association class III/IV congestive heart failure, or nephrotic syndromes, who were excluded from the CRIC study.


Hassanein M, Arrigain S, Schold JD, et al. Dysnatremias, mortality, and kidney failure in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Kidney Med. Published October 5, 2022. doi:10.1016/j.xkme.2022.100554