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Citation
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Bhandari SK, Adams AL, Li BH, Rhee CM, Sundar S, Krasa H, Danforth KN, Kanter MH, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ. Intern. Med. J. 2019; ePub(ePub): ePub. |
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Affiliation
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Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. |
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Abstract
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BACKGROUND: Falls and hip fractures among older people are associated with high morbidity and mortality. Hyponatremia may be a risk for falls/hip fractures, but the effect of hyponatremia duration is not well understood. AIMS: We sought to evaluate individuals with periods of sub-acute and chronic hyponatremia on subsequent risk for serious falls and/or hip fractures.
METHODS: Retrospective cohort study in the period 1/1/1998-6/14/2016 within an integrated health system of individuals aged ≥55 years with ≥2 outpatient serum sodium measurements. Hyponatremia was defined as sodium <135 mEq/L with sub-acute (<30 days) and chronic (>/=30 days) and analyzed as a time-dependent exposure. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios (HRs) for serious falls/hip fractures based on sodium category.
RESULTS: Among 1 062 647 individuals totaling 9 762 305 sodium measurements, 96 096 serious falls/hip fracture events occurred. Incidence (per-1000-person-years) of serious falls/hip fractures were 11.5, 27.9, and 19.8 for normonatremia, sub-acute, and chronic hyponatremia. Any hyponatremia duration compared to normonatremia had a serious falls/hip fractures HR (95%CI) of 1.18(1.15, 1.22), with sub-acute and chronic hyponatremia having HRs of 1.38(1.33, 1.42) and 0.91(0.87, 0.95), respectively. Examined separately, the serious falls HR was 1.37(1.32, 1.42) and 0.92(0.88, 0.96) in sub-acute and chronic hyponatremia, respectively. Hip fracture HRs were 1.52(1.42, 1.62) and 1.00(0.92, 1.08) for sub-acute and chronic hyponatremia, respectively, compared to normonatremia.
CONCLUSIONS: Our findings suggest that early/sub-acute hyponatremia appears more vulnerable and associated with serious falls/hip fractures. Whether hyponatremia is a marker of frailty or a modifiable risk factor for falls remains to be determined. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Language: en |