Hyponatremia and the risk of sepsis in the setting of chronic kidney disease not on dialysis

Abstract

Background Hyponatremia occurring in the presence of chronic kidney disease (CKD) is associated with increased mortality. Hyponatremia is also associated with sepsis in hypertensive patients without CKD taking thiazide diuretics. It is not known whether hyponatremia in CKD is associated with sepsis. Methods This retrospective cohort study addressed the hypothesis that hyponatremia in the setting of CKD is associated with sepsis. This study utilized the TriNetX federated health research network that contains medical records of approximately 93 million patients. Inclusion criteria: 40-90 years old, CKD stage 3, 4 or 5 occurring between 1 January 2010 and 31 December 2021. Hyponatremia cohort serum sodium is defined as ≤135 mmol/L. Comparison cohort has a serum sodium 136-144 mmol/L. Primary outcome is diagnosis with sepsis. Secondary outcomes are diagnosis with pneumonia, urinary tract infection, bacteremia, coronavirus disease 2019 (COVID-19), influenza, herpes zoster, meningitis, osteomyelitis and cellulitis. Results Patients in the hyponatremia cohort had a higher hazard of sepsis than comparison cohort [hazard ratio 1.683 (95% confidence interval 1.526, 1.857), P