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

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.

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References

  1. Adrogue HJ, Madias NE (2000) Hypernatremia. N Engl J Med 342(20):1493–1499

    PubMed  Article  CAS  Google Scholar 

  2. Schrier RW (2008) Vasopressin and aquaporin 2 in clinical disorders of water homeostasis. Semin Nephrol 28(3):289–296

    PubMed  Article  CAS  Google Scholar 

  3. Anderson RJ (1986) Hospital-associated hyponatremia. Kidney Int 29(6):1237–1247

    PubMed  Article  CAS  Google Scholar 

  4. Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29(3):227–238

    PubMed  Article  CAS  Google Scholar 

  5. Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122(9):857–865

    PubMed  Article  CAS  Google Scholar 

  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):222–228

    Article  CAS  Google Scholar 

  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):R162

    PubMed  Article  Google Scholar 

  8. Palevsky PM, Bhagrath R, Greenberg A (1996) Hypernatremia in hospitalized patients. Ann Intern Med 124(2):197–203

    PubMed  Article  CAS  Google Scholar 

  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–e7

    PubMed  Article  Google Scholar 

  10. Salahudeen AK, Bonventre JV (2013) Onconephrology: the latest frontier in the war against kidney disease. J Am Soc Nephrol: JASN 24(1):26–30

    PubMed  Article  Google Scholar 

  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):67–76

    PubMed  Article  Google Scholar 

  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

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Conflict of interest statement

We are submitting herewith the manuscript titled “The frequency, cost, and clinical outcomes of hypernatremia in patients hospitalized to a comprehensive cancer center”—to be considered for publication as an original article in Supportive Care in Cancer. There are no financial relationships to disclose for any of the authors. The manuscript has not been published elsewhere nor is it being considered for publication. We have full control of all primary data, and the journal is free to review these data if required.

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Correspondence to Abdulla K. Salahudeen.

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Salahudeen, A.K., Doshi, S.M. & Shah, P. The frequency, cost, and clinical outcomes of hypernatremia in patients hospitalized to a comprehensive cancer center. Support Care Cancer 21, 1871–1878 (2013). https://doi.org/10.1007/s00520-013-1734-6

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  • DOI: https://doi.org/10.1007/s00520-013-1734-6

Keywords

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