Hyponatremia in hospitalized patients with chronic kidney disease; aetiology, treatment, and outcome, in a tertiary care hospital, Dubai, UAE

Fakhriya Alalawi, Ayman Aly Seddik, Hussain Yousif, Mohammad Railey, Amna Alhadari


Background: Hyponatremia is common among hospitalized patients. Unfortunately, articles describing the management of profound hyponatremia (serum sodium <125 mEq/l) in the background of kidney disease are scarce. This review focuses on the incidence, prevalence, patient characteristics, and clinical features among hospitalized chronic kidney disease (CKD) patients with particular attention to CKD stage 3 to 5.

Methods: 71 adult patients with CKD stage 3 to 5 and had presented with profound hyponatremia (serum sodium <125 mEq/l) were included. Patient demographic data, laboratory parameters and treatment received were recorded. The primary endpoint was the development of central nervous syste (CNS) manifestations, while the secondary outcomes included early mortality (death within 30 days).

Results: 97 episodes of hyponatremia were recorded in 71 patients. 35 patients (49%) were UAE national and 53.5% patients were females. 52% were in CKD stage-5 refusing dialysis. Diabetic nephropathy was the underlying cause in 66%. The initial Sodium level upon admission ranged from 107-125 mEq/l, with a mean±standard deviation (SD) value of 117.7±4.54 mEq/l. The correction of hyponatremia had ranged between 24 hours in 60% of the patients to 96 hours. Diuretics were used in conjunction with the saline in 85%. Hospital stay ranged between 2-58 days (average 11.7 days). No CNS symptoms were recorded in any of the treated patients. Three patients had died (within 30 days) of sepsis of different sources.

Conclusions: Management of hyponatremia in CKD patients remains challenging and should be directed to the underlying cause. Yet, complex patients with advanced CKD particularly in concurrence with heart failure might represent a medical dilemma. Administering hypertonic saline in different mixed concentrations depending on the volume status of the patients appear to be safe, efficient, and suitable for high-risk CKD patients while monitoring Sodium level carefully.


Hyponatremia, Chronic kidney disease, Hypertonic saline

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Hoorn EJ, Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol. 2017;28(5):1340-9.

Giuliani C, Peri A. Effects of Hyponatremia on the Brain. J Clin Med. 2014;3(4):1163-77.

Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M. Clinical practice guideline on diagnosis and treatment of hyponatremia. Nephrol Dialysis Transplant. 2014;29(2):11-39.

Peri A, Thompson CJ, Verbalis JG. Disorders of Fluid and Electrolyte Metabolism. Focus on Hyponatremia. Front Horm Res. Basel, Karger. 2019;52:36-48.

Hyponatremia Correction Infusate Rate. Available at: calculator for hyponatremia. Accessed on 26 October 2020.

Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342(21):1581-9.

Sodium Correction Rate for Hyponatremia. Available at: Accessed on 26 November 2020.

Hanna RM, Yang WT, Lopez EA, Riad JN, Wilson J. The utility and accuracy of four equations in predicting sodium levels in dysnatremic patients. Clin Kidney J. 2016;9(4):530-9.

Lim LM, Tsai NC, Lin MY, Hwang DY, Lin HY, Lee JJ, Hwang SJ, Hung CC, Chen HC. Hyponatremia is Associated with Fluid Imbalance and Adverse Renal Outcome in Chronic Kidney Disease Patients Treated with Diuretics. Sci Rep. 2016;6:36817.

Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119(1):30-5.

Sahay M, Sahay R. Hyponatremia: a practical approach. Indian J Endocrinol Metab. 2014;18(6):760-71.

Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK. Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis. 2012;59(2):222-8.

Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A. Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One. 2015;10(4):e0124105.

Dubois GD, Arieff AI. Treatment of hyponatremia: the case for rapid correction. Narins RG, ed. Controversies in Nephrology and Hypertension. New York: Churchill Livingstone Inc. 1984;393-407.

Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med. 2009;122(9):857-65.

Huang H, Jolly SE, Airy M. Associations of dysnatremias with mortality in chronic kidney disease. Nephrol Dial Transplant. 2016.

Ahmed SS, Nur F, Ullah MR, Al Mamun A, Chowdhury MT, Laila TR, Khan MA. Factors Influencing Hyponatremia in Hospitalized Diabetic Patients-A Cross Sectional Study. Medicine Today. 2014;26(1):4-8.

Rao MY, Sudhir U, Anil Kumar T, Saravanan S, Mahesh E, Punith K. Hospital-based descriptive study of symptomatic hyponatremia in elderly patients. J Assoc Physicians India. 2010;58:667-9.

Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clinica Chimica Acta. 2003;337(1-2):169-72.

Grikinienė J, Volbekas V, Stakišaitis D. Gender differences of sodium metabolism and hyponatremia as an adverse drug effect. Medicina (Kaunas). 2004;40(10):935-42.

Liamis G, Tsimihodimos V, Elisaf M. Hyponatremia in diabetes mellitus: clues to diagnosis and treatment. J Diabetes Metab. 2015;6(5):559-61.

Soupart A, Decaux G. Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol. 1996;46(3):149.

Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med. 2014;40(3):320-31.

Mohmand HK, Issa D, Ahmad Z, Cappuccio JD, Kouides RW, Sterns RH. Hypertonic saline for hyponatremia: risk of inadvertent overcorrection. Clin J Am Soc Nephrol. 2007;2(6):1110-7.

Bhaskar E, Kumar B, Ramalakshmi S. Evaluation of a protocol for hypertonic saline administration in acute euvolemic symptomatic hyponatremia: A prospective observational trial. Indian J Crit Care Med. 2010;14(4):170-4.

Assadi F. Hyponatremia: a problem-solving approach to clinical cases. J Nephrol. 2012;25(4):473-80.