Supportive Care in Cancer

, Volume 21, Issue 7, pp 1871–1878 | Cite as

The frequency, cost, and clinical outcomes of hypernatremia in patients hospitalized to a comprehensive cancer center

  • Abdulla K. Salahudeen
  • Simit M. Doshi
  • Pankaj Shah
Original Article

Abstract

Purpose

To study the frequency of hypernatremia in hospitalized cancer patients and its impact on clinical outcomes and healthcare cost.

Methods

Cross-sectional analysis of data obtained from patients admitted to the University of Texas M. D. Anderson Cancer Center over a 3-month period in 2006. The clinical outcomes and hospital costs were compared among hypernatremics, eunatremics, and hyponatremics (serum sodium values include >147, 135–147, and <135 mEq/L, respectively).

Results

Of 3,446 patients with at least one serum sodium value, 51.4 % were eunatremic, 46.0 % hyponatremic, and 2.6 % hypernatremic with most of the hypernatremia (90 %) acquired during hospital stay. The multivariate hazard ratio (HR) for mortality in hypernatremic was 5-fold higher than eunatremic (HR for 90 days—5.09 (95 % CI, 3.32–7.81); p < 0·01) and over 2-fold higher than hyponatremic (HR for 90 days—2.79 (95 % CI, 1.91–4.11), p < 0.01). The length of hospital stay in hypernatremic was 2-fold higher than in hyponatremic and 4-fold higher than in eunatremic (e.g., 27 ± 22 days in hypernatremic vs. 6 ± 5 days in eunatremic; mean ± SD, p < 0.01). The hospital bill was higher for hypernatremic compared with the rest of the groups (46 % over eunatremic and 37 % over hyponatremic, p < 0.01 for both).

Conclusions

Although hypernatremia was far less frequent than hyponatremia in the hospitalized cancer patients, most hypernatremia were acquired in the hospital and had substantially higher mortality, hospital stay, and hospital bills than eunatremic or even hyponatremic patients. Studies are warranted to determine whether avoidance of hypernatremia or its prompt and sustained correction improves clinical outcomes.

Keywords

Hypernatremia Cancer Healthcare cost Survival Serum sodium Length of hospital stay Hyponatremia Electrolyte disorders Outcomes Leukemia 

References

  1. 1.
    Adrogue HJ, Madias NE (2000) Hypernatremia. N Engl J Med 342(20):1493–1499PubMedCrossRefGoogle Scholar
  2. 2.
    Schrier RW (2008) Vasopressin and aquaporin 2 in clinical disorders of water homeostasis. Semin Nephrol 28(3):289–296PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson RJ (1986) Hospital-associated hyponatremia. Kidney Int 29(6):1237–1247PubMedCrossRefGoogle Scholar
  4. 4.
    Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29(3):227–238PubMedCrossRefGoogle Scholar
  5. 5.
    Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122(9):857–865PubMedCrossRefGoogle Scholar
  6. 6.
    Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis: Offic J National Kidney Found 59(2):222–228CrossRefGoogle Scholar
  7. 7.
    Stelfox HT, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K (2008) The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical–surgical intensive care units. Crit Care 12(6):R162PubMedCrossRefGoogle Scholar
  8. 8.
    Palevsky PM, Bhagrath R, Greenberg A (1996) Hypernatremia in hospitalized patients. Ann Intern Med 124(2):197–203PubMedCrossRefGoogle Scholar
  9. 9.
    Arampatzis S, Frauchiger B, Fiedler GM, Leichtle AB, Buhl D, Schwarz C et al (2012) Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. The American journal of medicine 125(11):1125, e1–e7PubMedCrossRefGoogle Scholar
  10. 10.
    Salahudeen AK, Bonventre JV (2013) Onconephrology: the latest frontier in the war against kidney disease. J Am Soc Nephrol: JASN 24(1):26–30PubMedCrossRefGoogle Scholar
  11. 11.
    Elsayem A, Mori M, Parsons HA, Munsell MF, Hui D, Delgado-Guay MO et al (2010) Predictors of inpatient mortality in an acute palliative care unit at a comprehensive cancer center. Support Care Cancer 18(1):67–76PubMedCrossRefGoogle Scholar
  12. 12.
    Salahudeen AK, Doshi SM, Pawar T, Nowshad G, Lahoti A, Shah P (2013) Incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a comprehensive cancer center. Clin J Am Soc Nephrol. doi:10.2215/CJN.03530412

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Abdulla K. Salahudeen
    • 1
    • 3
  • Simit M. Doshi
    • 1
  • Pankaj Shah
    • 2
  1. 1.Division of Internal MedicineUT MD Anderson Cancer CenterHoustonUSA
  2. 2.Division of EndocrinologyMayo ClinicRochesterUSA
  3. 3.Department of General Internal MedicineUniversity of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations