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Understanding Hyponatremia

Incidence and Impact

Hyponatremia is the most common form of electrolyte imbalance, affecting more than 6 million Americans each year and incurring costs of up to $3.6 billion.^1,2

Increases in morbidity and mortality

Many studies have shown that hyponatremia can increase the risks of morbidity and mortality in a wide range of patients. For example:

• In a study of more than 400 heart failure patients, persistent hyponatremia (defined as serum sodium concentration ≤134 mEq/L for the duration of hospitalization for heart failure) was associated with a significantly higher risk of 6-month mortality (adjusted hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.03-3.22; P=.04) and of heart failure rehospitalization (adjusted HR, 1.52; 95% CI, 1.05-2.22; P=.03)³
• In a study of more than 14,000 patients awaiting liver transplant, each unit decrease in serum sodium concentration (from 140 to 125 mEq/L) was associated with a 5% increase in the risk of death (HR, 1.05; 95% CI, 1.03-1.08; P<.001)⁴
• In a study of 4000 elderly hospitalized patients, the risk of mortality increased with the severity of hyponatremia⁵

Impact on cost of care

Hyponatremia can also have a major impact on cost of care. As noted, estimates of the costs of hyponatremia in the United States range as high as $3.6 billion each year.² In addition, hyponatremia has been found to be a significant, independent predictor of inpatient costs at 6 months (41.2% increase; 95% CI, 30.3%-53.0%) and 1 year (45.7% increase; 95% CI, 34.2%-58.2%).⁶

NEXT: Video Presentation—Hyponatremia: Incidence and Consequences

References: 1. Janicic N, Verbalis JG. Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am. 2003;32:459-481. 2. Boscoe A, Paramore C, Verbalis JG. Cost of illness of hyponatremia in the United States. Cost Eff Resour Alloc. 2006;4:10. 3. Gheorghiade M, Rossi JS, Cotts W, et al. Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial. Arch Intern Med. 2007;167:1998-2005. 4. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018-1026. 5. Terzian C, Frye EB, Piotrowski ZH. Admission hyponatremia in the elderly: factors influencing prognosis. J Gen Intern Med. 1994;9:89-91. 6. Shea AM, Hammill BG, Curtis LH, Szczech LA, Schulman KA. Medical costs of abnormal serum sodium levels. J Am Soc Nephrol. 2008;19:764-770.