Clin J Am Soc Nephrol. 2023 Sep 18. doi: 10.2215/CJN.0000000000000250. Online ahead of print.
BACKGROUND: Hospital-acquired hypernatremia is highly prevalent, overlooked and is associated with unfavorable consequences. There are limited studies examining the outcomes and discharge dispositions of various levels of hospital-acquired hypernatremia in patients with or without chronic kidney disease.
METHODS: We conducted an observational retrospective cohort study, and we analyzed the data of 1,728,141 million patients extracted from the Cerner Health Facts database (January 1st 2000- June 30th 2018). In this report we investigated the association between hospital-acquired hypernatremia (serum sodium (Na) levels>145 mEq/L) and in-hospital mortality or discharge dispositions with kidney function status at admission using adjusted multinomial regression models.
RESULTS: Of all hospitalized patients, 6% developed hypernatremia after hospital admission. Incidence of in-hospital mortality was 12% and 1% in hyper- and normonatremic patients, respectively. The risk of all outcomes was significantly greater for serum Na >145 mEq/L compared to the reference interval (serum Na: 135-145 mEq/L). In hypernatremic patients, odds ratios (ORs) (95% confidence interval) for in-hospital mortality, discharge to hospice and discharge to nursing facilities were 14.04 (13.71-14.38), 4.35 (4.14-4.57) and 3.88 (3.82-3.94), respectively (p<0.001, for all). Patients with estimated glomerular filtration rate (CKD-EPI) 60-89 mL/min/1.73 m2 and normonatremia had the lowest OR for in-hospital mortality (1.60 [1.52-1.70]).
CONCLUSIONS: Hospital-acquired hypernatremia is associated with in-hospital mortality as well as discharge to hospice or to nursing facility in all stages of CKD.