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Erschienen in: Supportive Care in Cancer 1/2018

18.08.2017 | Original Article

Prevalence of hyponatremia in inpatients with incurable and life-limiting diseases and its association with physical symptoms—a retrospective descriptive study

verfasst von: Kerstin Kremeike, Ricarda M. L. Wetter, Volker Burst, Raymond Voltz, Kathrin Kuhr, Steffen T. Simon

Erschienen in: Supportive Care in Cancer | Ausgabe 1/2018

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Abstract

Purpose

Hyponatremia is a common electrolyte abnormality seen in hospitalized patients. It may cause a variety of symptoms and is associated with longer hospitalizations and higher mortality. However, to date, only little is known about the extent of hyponatremia in patients with incurable diseases and whether it is associated with physical symptoms in this patient group. This study aims to describe the prevalence of hyponatremia, associated symptoms, and symptom intensity in inpatients with hyponatremia receiving specialist palliative care (SPC).

Methods

This is a retrospective study. Demographic and clinical data as well as symptoms, scored symptom intensity, and laboratory values were collected. All inpatients of a large German University Hospital receiving SPC in 2013 with documented sodium values were included.

Results

In 2013, 789 inpatients received SPC of which 710 had documented sodium values. The prevalence of hyponatremia was 38.7% (275/710). A mild degree showed 220 (31,0%), 44 (6.2%) had a moderate, and 11 (1.6%) a severe form. Hyponatremia patients experienced significantly more symptoms than normonatremic patients (mean = 7.71 vs 6.63; p < 0.001). Breathlessness, depressiveness, nausea, vomiting, poor appetite, constipation, and weakness were significantly more frequent in patients with hyponatremia. Furthermore, hyponatremia severity was associated with higher symptom intensity (mean = 13.29 vs 11.28; p < 0.001).

Conclusions

More than one third of all SPC patients showed a hyponatremia, and the hyponatremia grade was associated with symptom burden and symptom intensity. A prospective analysis is needed to further examine this association and the possible influence of hyponatremia correction on symptom burden reduction.
Literatur
5.
Zurück zum Zitat Greenberg A, Verbalis JG, Amin AN, Burst VR, Chiodo JA 3rd, Chiong JR, Dasta JF, Friend KE, Hauptman PJ, Peri A, Sigal SH (2015) Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int 88(1):167–177. doi:10.1038/ki.2015.4 CrossRefPubMedPubMedCentral Greenberg A, Verbalis JG, Amin AN, Burst VR, Chiodo JA 3rd, Chiong JR, Dasta JF, Friend KE, Hauptman PJ, Peri A, Sigal SH (2015) Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int 88(1):167–177. doi:10.​1038/​ki.​2015.​4 CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Nigro N, Winzeler B, Suter-Widmer I, Schuetz P, Arici B, Bally M, Blum C, Bingisser R, Bock A, Huber A, Muller B, Nickel CH, Christ-Crain M (2015) Symptoms and characteristics of individuals with profound hyponatremia: a prospective multicenter observational study. J Am Geriatr Soc 63(3):470–475. doi:10.1111/jgs.13325 CrossRefPubMed Nigro N, Winzeler B, Suter-Widmer I, Schuetz P, Arici B, Bally M, Blum C, Bingisser R, Bock A, Huber A, Muller B, Nickel CH, Christ-Crain M (2015) Symptoms and characteristics of individuals with profound hyponatremia: a prospective multicenter observational study. J Am Geriatr Soc 63(3):470–475. doi:10.​1111/​jgs.​13325 CrossRefPubMed
7.
Zurück zum Zitat Balling L, Gustafsson F, Goetze JP, Dalsgaard M, Nielsen H, Boesgaard S, Bay M, Kirk V, Nielsen OW, Kober L, Iversen K (2015) Hyponatraemia at hospital admission is a predictor of overall mortality. Intern Med J 45(2):195–202. doi:10.1111/imj.12623 CrossRefPubMed Balling L, Gustafsson F, Goetze JP, Dalsgaard M, Nielsen H, Boesgaard S, Bay M, Kirk V, Nielsen OW, Kober L, Iversen K (2015) Hyponatraemia at hospital admission is a predictor of overall mortality. Intern Med J 45(2):195–202. doi:10.​1111/​imj.​12623 CrossRefPubMed
8.
Zurück zum Zitat Sepulveda C, Marlin A, Yoshida T, Ullrich A (2002) Palliative care: the World Health Organization's global perspective. J Pain Symptom Manag 24(2):91–96CrossRef Sepulveda C, Marlin A, Yoshida T, Ullrich A (2002) Palliative care: the World Health Organization's global perspective. J Pain Symptom Manag 24(2):91–96CrossRef
12.
Zurück zum Zitat Mallik S, Mallik G, Macabulos ST, Dorigo A (2016) Malignancy associated hypercalcaemia-responsiveness to IV bisphosphonates and prognosis in a palliative population. Support Care Cancer : O J Multinatl Assoc Support Care Cancer 24(4):1771–1777. doi:10.1007/s00520-015-2962-8 CrossRef Mallik S, Mallik G, Macabulos ST, Dorigo A (2016) Malignancy associated hypercalcaemia-responsiveness to IV bisphosphonates and prognosis in a palliative population. Support Care Cancer : O J Multinatl Assoc Support Care Cancer 24(4):1771–1777. doi:10.​1007/​s00520-015-2962-8 CrossRef
13.
Zurück zum Zitat Simon ST, Altfelder N, Alt-Epping B, Bausewein C, Weingartner V, Voltz R, Ostgathe C, Radbruch L, Lindena G (1946) Nauck F (2016) [characteristics of patients with breathlessness - results of the german hospice and palliative care evaluation]. Dtsch Med Wochenschr 141(10):e87–e95. doi:10.1055/s-0041-106678 CrossRef Simon ST, Altfelder N, Alt-Epping B, Bausewein C, Weingartner V, Voltz R, Ostgathe C, Radbruch L, Lindena G (1946) Nauck F (2016) [characteristics of patients with breathlessness - results of the german hospice and palliative care evaluation]. Dtsch Med Wochenschr 141(10):e87–e95. doi:10.​1055/​s-0041-106678 CrossRef
14.
Zurück zum Zitat Simon ST, Altfelder N, Alt-Epping B, Bausewein C, Weingartner V, Voltz R, Ostgathe C, Radbruch L, Lindena G, Nauck F (2014) Is breathlessness what the professional says it is? Analysis of patient and professionals' assessments from a German nationwide register. Support Care Cancer : O J Multinatl Assoc Support Care Cancer 22(7):1825–1832. doi:10.1007/s00520-014-2131-5 CrossRef Simon ST, Altfelder N, Alt-Epping B, Bausewein C, Weingartner V, Voltz R, Ostgathe C, Radbruch L, Lindena G, Nauck F (2014) Is breathlessness what the professional says it is? Analysis of patient and professionals' assessments from a German nationwide register. Support Care Cancer : O J Multinatl Assoc Support Care Cancer 22(7):1825–1832. doi:10.​1007/​s00520-014-2131-5 CrossRef
15.
16.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRef
17.
Zurück zum Zitat Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251CrossRef Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251CrossRef
19.
Zurück zum Zitat Abu Zeinah GF, Al-Kindi SG, Hassan AA, Allam A (2015) Hyponatraemia in cancer: association with type of cancer and mortality. Eur J Cancer Care 24(2):224–231. doi:10.1111/ecc.12187 CrossRef Abu Zeinah GF, Al-Kindi SG, Hassan AA, Allam A (2015) Hyponatraemia in cancer: association with type of cancer and mortality. Eur J Cancer Care 24(2):224–231. doi:10.​1111/​ecc.​12187 CrossRef
20.
Zurück zum Zitat Choi JS, Bae EH, Ma SK, Kweon SS, Kim SW (2015) Prognostic impact of hyponatraemia in patients with colorectal cancer. Colorectal Disease : J Assoc Coloproctology Great Britain Ireland 17(5):409–416. doi:10.1111/codi.12878 CrossRef Choi JS, Bae EH, Ma SK, Kweon SS, Kim SW (2015) Prognostic impact of hyponatraemia in patients with colorectal cancer. Colorectal Disease : J Assoc Coloproctology Great Britain Ireland 17(5):409–416. doi:10.​1111/​codi.​12878 CrossRef
22.
Zurück zum Zitat Darmon M, Diconne E, Souweine B, Ruckly S, Adrie C, Azoulay E, Clec'h C, Garrouste-Orgeas M, Schwebel C, Goldgran-Toledano D, Khallel H, Dumenil AS, Jamali S, Cheval C, Allaouchiche B, Zeni F, Timsit JF (2013) Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Critical Care (London, England) 17(1):R12. doi:10.1186/cc11937 CrossRef Darmon M, Diconne E, Souweine B, Ruckly S, Adrie C, Azoulay E, Clec'h C, Garrouste-Orgeas M, Schwebel C, Goldgran-Toledano D, Khallel H, Dumenil AS, Jamali S, Cheval C, Allaouchiche B, Zeni F, Timsit JF (2013) Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Critical Care (London, England) 17(1):R12. doi:10.​1186/​cc11937 CrossRef
23.
Zurück zum Zitat Yoon J, Ahn SH, Lee YJ, Kim CM (2015) Hyponatremia as an independent prognostic factor in patients with terminal cancer. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 23(6):1735–1740. doi:10.1007/s00520-014-2522-7 CrossRef Yoon J, Ahn SH, Lee YJ, Kim CM (2015) Hyponatremia as an independent prognostic factor in patients with terminal cancer. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 23(6):1735–1740. doi:10.​1007/​s00520-014-2522-7 CrossRef
24.
Zurück zum Zitat Moens K, Higginson IJ, Harding R (2014) Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manag 48(4):660–677. doi:10.1016/j.jpainsymman.2013.11.009 CrossRef Moens K, Higginson IJ, Harding R (2014) Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manag 48(4):660–677. doi:10.​1016/​j.​jpainsymman.​2013.​11.​009 CrossRef
25.
Zurück zum Zitat Arampatzis S, Frauchiger B, Fiedler GM, Leichtle AB, Buhl D, Schwarz C, Funk GC, Zimmermann H, Exadaktylos AK, Lindner G (2012) Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. The Am J Med 125(11):1125 e1121–1125 e1127. doi:10.1016/j.amjmed.2012.04.041 CrossRef Arampatzis S, Frauchiger B, Fiedler GM, Leichtle AB, Buhl D, Schwarz C, Funk GC, Zimmermann H, Exadaktylos AK, Lindner G (2012) Characteristics, symptoms, and outcome of severe dysnatremias present on hospital admission. The Am J Med 125(11):1125 e1121–1125 e1127. doi:10.​1016/​j.​amjmed.​2012.​04.​041 CrossRef
28.
Zurück zum Zitat Berardi R, Caramanti M, Castagnani M, Guglielmi S, Marcucci F, Savini A, Morgese F, Rinaldi S, Ferrini C, Tiberi M, Torniai M, Rovinelli F, Fiordoliva I, Onofri A, Cascinu S (2015) Hyponatremia is a predictor of hospital length and cost of stay and outcome in cancer patients. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 23(10):3095–3101. doi:10.1007/s00520-015-2683-z CrossRef Berardi R, Caramanti M, Castagnani M, Guglielmi S, Marcucci F, Savini A, Morgese F, Rinaldi S, Ferrini C, Tiberi M, Torniai M, Rovinelli F, Fiordoliva I, Onofri A, Cascinu S (2015) Hyponatremia is a predictor of hospital length and cost of stay and outcome in cancer patients. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 23(10):3095–3101. doi:10.​1007/​s00520-015-2683-z CrossRef
29.
Zurück zum Zitat Rondon-Berrios H, Berl T (2015) Mild chronic hyponatremia in the ambulatory setting: significance and management. Clinical J Am Soc Nephrol : CJASN 10(12):2268–2278. doi:10.2215/cjn.00170115 CrossRef Rondon-Berrios H, Berl T (2015) Mild chronic hyponatremia in the ambulatory setting: significance and management. Clinical J Am Soc Nephrol : CJASN 10(12):2268–2278. doi:10.​2215/​cjn.​00170115 CrossRef
30.
Zurück zum Zitat Elsayem A, Mori M, Parsons HA, Munsell MF, Hui D, Delgado-Guay MO, Paraskevopoulos T, Fadul NA, Bruera E (2010) Predictors of inpatient mortality in an acute palliative care unit at a comprehensive cancer center. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 18(1):67–76. doi:10.1007/s00520-009-0631-5 CrossRef Elsayem A, Mori M, Parsons HA, Munsell MF, Hui D, Delgado-Guay MO, Paraskevopoulos T, Fadul NA, Bruera E (2010) Predictors of inpatient mortality in an acute palliative care unit at a comprehensive cancer center. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 18(1):67–76. doi:10.​1007/​s00520-009-0631-5 CrossRef
31.
32.
Zurück zum Zitat Vincent F, Ayed S, Bouguerba A, Goldgran-Toledano D, Bornstain C (2016) Hyponatremia in solid-tumor cancer patients: uncertainty regarding the use of vaptans. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 24(9):3685–3686. doi:10.1007/s00520-016-3178-2 CrossRef Vincent F, Ayed S, Bouguerba A, Goldgran-Toledano D, Bornstain C (2016) Hyponatremia in solid-tumor cancer patients: uncertainty regarding the use of vaptans. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 24(9):3685–3686. doi:10.​1007/​s00520-016-3178-2 CrossRef
Metadaten
Titel
Prevalence of hyponatremia in inpatients with incurable and life-limiting diseases and its association with physical symptoms—a retrospective descriptive study
verfasst von
Kerstin Kremeike
Ricarda M. L. Wetter
Volker Burst
Raymond Voltz
Kathrin Kuhr
Steffen T. Simon
Publikationsdatum
18.08.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Supportive Care in Cancer / Ausgabe 1/2018
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-017-3837-y

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