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Effect of Hyponatremia and its Normalization on Patients’ Clinical Outcomes and Bone Metabolism

Potasso, Laura. Effect of Hyponatremia and its Normalization on Patients’ Clinical Outcomes and Bone Metabolism. 2021, Doctoral Thesis, University of Basel, Faculty of Medicine.

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Abstract

Background: Hyponatremia is an electrolyte disorder affecting up to 40% of hospitalized patients, and has widely been associated with increased risk of death, rehospitalizations, as well as with falls, fractures and osteoporosis, when present on admission. Despite this association, knowledge about beneficial effects of its correction is scare. Additionally, hyponatremia is mostly considered as a surrogate of disease severity rather than a treatable trait, resulting in many patients being and / or remaining hyponatremic at discharge.
Objective: This MD-PhD thesis investigates the hypothesis that correction of hyponatremia in hospitalized, adult patients improves their clinical outcome, with particular focus on bone metabolism.
Methods: The first study is a secondary analysis of a prospective, placebo-controlled trial to understand the impact of hyponatremia at discharge on clinical outcomes in hospitalized patients with pneumonia. The second study is a registry analysis to investigate the impact of persistency versus normalization of admission hyponatremia on clinical outcomes in hospitalized patients with stroke. The third and main study is the analysis of plasma bone marker changes in relation to serum sodium levels during a prospective, placebo-controlled interventional trial in hospitalized patients with syndrome of inappropriate antidiuresis- (SIAD) induced hyponatremia.
Results: Overall, all three studies support the hypothesis that in-hospital correction of hyponatriemia improves the outcome of affected patients. In the setting of pneumonia, hyponatremia at discharge is associated with increased risk of a recurrence within 6 months. In patients with stroke, persistency of initial hyponatremia is associated with a worse functional outcome at 3 months. In patients with SIAD, a targeted correction of hyponatremia stimulates bone formation.
Discussion: Newly developed or persistent hyponatremia at discharge is associated with worse clinical outcomes in hospitalized patients. Correction of hyponatremia reverses the hyponatremia-induced negative effect on bone metabolism by stimulating bone formation. Further interventional studies are needed to clarify whether correction of hyponatremia could improve other hyponatremia associated patients’ relevant clinical outcomes analogue to improving bone metabolism as well as long-term of this effect.
Advisors:Christ-Crain, Mirjam
Committee Members:Meier , Christian and Peri, Alessandro
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Endokrinologie / Diabetologie > Endokrinologie (Christ-Crain)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Endokrinologie / Diabetologie > Endokrinologie (Christ-Crain)
UniBasel Contributors:Christ-Crain, Mirjam
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:14857
Thesis status:Complete
Number of Pages:107
Language:English
Identification Number:
  • urn: urn:nbn:ch:bel-bau-diss148579
edoc DOI:
Last Modified:23 Nov 2022 05:30
Deposited On:22 Nov 2022 08:41

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