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Association of early hyponatremia and the development of acute kidney injury in critically ill children

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Abstract

Background

Hyponatremia is an independent prognostic factor for mortality; however, the reason for this remains unclear. An observed relationship between hyponatremia and the development of acute kidney injury (AKI) has been reported in certain disease states, but hyponatremia has not been evaluated as a predictor of AKI in critically ill patients or children.

Methods

This is a single-center retrospective cohort study of critically ill children admitted to a tertiary care center. We performed regression analysis to assess the association between hyponatremia at ICU admission and the development of new or worsening stage 2 or 3 (severe) AKI on days 2–3 following ICU admission.

Results

Among the 5057 children included in the study, early hyponatremia was present in 13.3% of children. Severe AKI occurred in 9.2% of children with hyponatremia compared to 4.5% of children with normonatremia. Following covariate adjustment, hyponatremia at ICU admission was associated with a 75% increase in the odds of developing severe AKI when compared to critically ill children with normonatremia (aOR 1.75, 95% CI 1.28–2.39). Evaluating sodium levels continuously, for every 1 mEq/L decrease in serum sodium level, there was a 0.05% increase in the odds of developing severe AKI (aOR 1.05, 95% CI 1.02–1.08). Hyponatremic children who developed severe AKI had a higher frequency of kidney replacement therapy, AKI or acute kidney disease at hospital discharge, and hospital mortality when compared to those without.

Conclusions

Hyponatremia at ICU admission is associated with the development of new or worsening AKI in critically ill children.

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Availability of data and material

Data is not publicly available.

Code availability

Code for the statistical analysis can be provided upon request.

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Acknowledgements

We would like to thank the Biostatistical and Data Management Core within the CRISMA (Clinical Research Investigation and Systems Modeling of Acute Illness) Center for their help in variable development as well as data acquisition, management, and storage.

Funding

This study was supported by the National Institutes of Health (T32 DK 91202 and UL1-TR-001857).

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Cassandra L. Formeck & Michael L. Moritz

  2. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA

    Cassandra L. Formeck, Emily L. Joyce & John A. Kellum

  3. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

    Nalyn Siripong

  4. Division of Nephrology, Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA

    Emily L. Joyce

  5. School of Medicine, University of California, Irvine, CA, USA

    Juan C. Ayus

  6. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA

    John A. Kellum

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  1. Cassandra L. Formeck
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Contributions

Research idea and study design, CF, EJ, JCA, JK, and MM; data acquisition, CF, EJ, and JK; data analysis/interpretation, CF, EJ, JCA, JK, and MM; statistical analysis, CF and NS; and supervision or mentorship, JCA, JK, and MM. Each author contributed important intellectual content during manuscript drafting or revision, accepts personal accountability for the author’s own contributions, and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Cassandra L. Formeck.

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Formeck, C.L., Siripong, N., Joyce, E.L. et al. Association of early hyponatremia and the development of acute kidney injury in critically ill children. Pediatr Nephrol 37, 2755–2763 (2022). https://doi.org/10.1007/s00467-022-05478-5

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