Preoperative Sodium Predicts Outcomes in Patients with Chronic Kidney Disease undergoing Cardiac Surgery

Shuli Silberman Cardiothoracic surgery, Shaare Zedek Medical Center, Jerusalem, Israel Ofer Merin Cardiothoracic surgery, Shaare Zedek Medical Center, Jerusalem, Israel Tal Grenader Onclology, Shaare Zedek Medical Center, Jerusalem, Israel Chani Waldenberg Cardiothoracic surgery, Shaare Zedek Medical Center, Jerusalem, Israel Daniel Bitran Cardiothoracic surgery, Shaare Zedek Medical Center, Jerusalem, Israel Daniel Fink Cardiothoracic surgery, Shaare Zedek Medical Center, Jerusalem, Israel Linda Shavit Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel

Background: Hyponatremia adversely impacts outcomes of cardiothoracic surgery. In patients with chronic kidney disease (CKD), the association of sodium levels on postoperative events has never been evaluated. We investigated the impact of preoperative hyponatremia on outcomes after cardiac surgery in patients with non–dialysis-dependent CKD. Endpoints were operative mortality, acute kidney injury (AKI) necessitating dialysis, and infection.

Methods: Included are all patients with stage III-IV CKD (non-dialysis) undergoing cardiac surgery between 2000-2016. Patients were stratified into 2 groups by preoperative sodium levels: Na

Results: A total of 1008 patients (mean eGFR 43 ± 14 mL/min/1.73 m2) were evaluated: 92 (9%) were in group 1. Patients with low sodium had higher operative mortality [25 (27%) and 103 (11%); p<0.0001]; more need for new dialysis [13 (14%) and 44 (5%) p=0.0002] and more serious infection [24 (26%) and 128 (14%); p=0.002]. Predictors of operative mortality were: EuroSCORE (OR 1.04; 95% CI 1.004–1.05, p<0.0001); Sodium

Conclusions: Preoperative hyponatremia is a predictor of increased mortality as well as other adverse events in patients with non- dialysis dependent CKD undergoing cardiac surgery. It is also associated with reduced long-term survival. These findings are similar to those in hyponatremic patients without CKD.

Presentation

Shuli Silberman

Shaare Zedek Medical Center