{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:23:00Z","timestamp":1778084580370,"version":"3.51.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"publisher","award":["413657723"],"award-info":[{"award-number":["413657723"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,29]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The 5-year mortality rate for haemodialysis patients is over 50%. Acute and chronic disturbances in salt and fluid homeostasis contribute to poor survival and are established as individual mortality risk factors. However, their interaction in relation to mortality is unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used the European Clinical Database 5 to investigate in a retrospective cohort analysis the relationship between transient hypo- and hypernatremia, fluid status and mortality risk of 72\u00a0163 haemodialysis patients from 25 countries. Incident haemodialysis patients with at least one valid measurement of bioimpedance spectroscopy were followed until death or administrative censoring from 1 January 2010 to 4 December 2019. Fluid overload and depletion were defined as &amp;gt;2.5\u00a0L above, and \u22121.1\u00a0L below normal fluid status, respectively. N\u00a0=\u00a02\u00a0272\u00a0041 recorded plasma sodium and fluid status measurements were available over a monthly time grid and analysed in a Cox regression model for time-to-death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mortality risk of hyponatremia (plasma sodium &amp;lt;135\u00a0mmol\/L) was slightly increased when fluid status was normal [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.18\u20131.35], increased by half when patients were fluid depleted (HR 1.56, 95% CI 1.27\u20131.93) and accelerated during fluid overload (HR 1.97, 95% CI 1.82\u20132.12).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Plasma sodium and fluid status act independently as risk factors on mortality. Patient surveillance of fluid status is especially important in the high-risk subpopulation of patients with hyponatremia. Prospective patient-level studies should examine the effects of chronic hypo- and hypernatremia, risk determinants, and their outcome risk.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfad041","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T13:18:46Z","timestamp":1677763126000},"page":"2248-2256","source":"Crossref","is-referenced-by-count":8,"title":["Hyponatraemia and fluid overload are associated with higher risk of mortality in dialysis patients"],"prefix":"10.1093","volume":"38","author":[{"given":"Jule","family":"Pinter","sequence":"first","affiliation":[{"name":"University Hospital W\u00fcrzburg , W\u00fcrzburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Genser","sequence":"additional","affiliation":[{"name":"Centre for Preventive Medicine & Digital Health Baden W\u00fcrttemberg, Ruprecht Karls University Heidelberg , Mannheim , Germany"},{"name":"High5Data GmbH , Heidelberg , 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