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Association between pre hemodialysis serum sodium concentration and blood pressure: results from a retrospective analysis from the international monitoring dialysis outcomes (MONDO) initiative

Journal of Human Hypertension volume 30, pages 442–448 (2016)Cite this article

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Abstract

A recent study from the United Kingdom indicates an association between pre hemodialysis (HD) serum sodium (SNa+) and systolic and diastolic blood pressure (SBP and DBP) in chronic HD patients. We extend this analysis to an international cohort of incident HD patients. The Monitoring Dialysis Outcomes initiative encompasses patients from 41 countries. Over 2 years monthly pre-HD SNa+ levels were used as predictors of pre-HD SBP and DBP in a linear mixed model (LMM) adjusted for age, gender, interdialytic weight gain, diabetes, serum albumin and calcium. Similar models were constructed with DBP as outcome. Analyses were carried out stratified by continent (North and South America; Europe and Asia). LMMs were also constructed for the entire observation period of 2 years, and separately the first and the second year after HD initiation. We studied 17 050 incident patients and found SNa+ to have a significant slope estimate in the LMM predicting pre-HD SBP and DBP (ranging from 0.22 to 0.29 and 0.10 to 0.21 mm Hg per mEq l−1, respectively, between the continents). The findings were similar in subsets of SBP and SNa+ tertiles, and separately analyzed for the first and second year. Our analysis shows an independent association between SNa, SBP and DBP in a large intercontinental database, indicating that this relation is a profound biological phenomenon in incident and prevalent HD patients, generalizable to an international level and independent of SBP and DBP magnitude.

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Acknowledgements

The results presented in this paper have not been published previously in whole or part, except for presentation as a poster at the Renal Week 2013 of the American Society of Nephrology in Atlanta, GA, USA.

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Authors and Affiliations

  1. Research Division, Renal Research Institute, New York, NY, USA

    J G Raimann, N W Levin, S Thijssen, L A Usvyat & P Kotanko

  2. Fresenius Medical Care, Europe, Middle East, Africa, Latin America

    B Canaud, D Marcelli & P Carioni

  3. Fresenius Medical Care Asia-Pacific, Hong Kong, People's Republic of China

    M Etter & X Xu

  4. Maastricht University Medical Centre, Maastricht, The Netherlands

    J P Kooman & F M van der Sande

  5. Fresenius Medical Care, Buenos Aires, Argentina

    C Marelli

  6. Imperial College, London, UK

    A Power & N Duncan

  7. Fresenius Medical Care North America, Waltham, MA, USA

    L A Usvyat

  8. University of California Santa Barbara, Santa Barbara, CA, USA

    Y Wang

  9. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    P Kotanko

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  1. J G Raimann
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  2. B Canaud
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  3. M Etter
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  14. L A Usvyat
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the MONDO Initiative

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Correspondence to J G Raimann.

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Competing interests

Drs Bernard Canaud, Peter Kotanko and Nathan W Levin hold stock in Fresenius Medical Care. The remaining authors declare no conflict of interest.

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Supplementary Information accompanies this paper on the Journal of Human Hypertension website

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Raimann, J., Canaud, B., Etter, M. et al. Association between pre hemodialysis serum sodium concentration and blood pressure: results from a retrospective analysis from the international monitoring dialysis outcomes (MONDO) initiative. J Hum Hypertens 30, 442–448 (2016). https://doi.org/10.1038/jhh.2015.79

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