Hyponatremia in Hospitalized Cancer Patients and Its Impact on Clinical Outcomes

Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA.
American Journal of Kidney Diseases (Impact Factor: 5.9). 02/2012; 59(2):222-8. DOI: 10.1053/j.ajkd.2011.08.029
Source: PubMed


Hyponatremia is the most common electrolyte abnormality in clinical practice, yet little is known about its frequency in patients with cancer or its impact on their clinical outcomes.
Retrospective analysis of prospectively collected data.
Patients with cancer admitted to the University of Texas M.D. Anderson Cancer Center in 2006 for 3 months.
Serum sodium levels categorized as eunatremia (serum sodium, 135-147 mEq/L) and mild (134-130 mEq/L), moderate (129-120 mEq/L), and severe (<120 mEq/L) hyponatremia.
(1) Length of hospital stay and (2) 90-day mortality.
In 4,702 admissions in 3,357 patients with cancer, hyponatremia (serum sodium <135 mEq/L) was noted in 47% of admissions. It was mild in 36%, moderate in 10%, and severe in 1%. Hyponatremia was acquired during the hospital stay in 24%. Using the first admission data, mean length of stay was 5.6 ± 5.0 days for patients with eunatremia and 9.9 ± 9.2, 13.0 ± 14.1, and 11.5 ± 12.6 days for those with mild, moderate, and severe hyponatremia, respectively. The respective HRs in the multivariate Cox model for longer hospital stay, using patients with eunatremia as reference, were 1.92 (95% CI, 1.75-2.13; P < 0.01), 2.94 (95% CI, 2.56-3.45; P < 0.01), and 2.32 (95% CI, 1.32-4.00; P = 0.01). 283 (8.4%) deaths occurred during 90 days, and in the multivariate model, the respective HRs for 90-day mortality for mild, moderate, and severe hyponatremia were 2.04 (95% CI, 1.42-2.91; P < 0.01); 4.74 (95% CI, 3.21-7.01; P < 0.01), and 3.46 (95% CI, 1.05-11.44; P = 0.04). These findings were consistent when analyses were repeated with sodium levels in tertiles.
Observational study, retrospective, inability to adjust for all comorbid conditions.
Hyponatremia in patients with cancer is associated with longer hospital stay and higher mortality. Whether long-term correction of hyponatremia would improve these outcomes remains to be determined.

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Available from: Amit Lahoti, Jun 12, 2014
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    • "However, its prevalence of acute admissions in specific patient groups particularly in the area at risk of tropical infectious diseases [4] [5] is surprisingly poorly documented. Although patients often do not report symptoms of hyponatremia, it is not a benign condition being associated with abnormalities in physical and mental function [6] , increased morbidity and mortality [7] [8] [9] , and increased in-hospital costs [9] [10] . Patients with mild hyponatremia frequently present again with more severe disturbance if a diagnosis is not made and the abnormality is not corrected [11] . "
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    • "The relationship between hyponatremia and increased mortality has been recognized, primarily in patients with heart failure and liver cirrhosis [3-7]. Recent studies have additionally revealed this association in a wide variety of diseases including myocardial infarction [2,8], pulmonary embolism [9], cancer [2,10] and pneumonia [11], and in patients in perioperative settings [1,12] and those in intensive care units [13]. Similar observations have been made in chronic kidney disease (CKD) patients with [14-16] and without end-stage renal disease (ESRD) [17]. "
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