The Relationship Between Rate of Hypernatremia Correction and Outcomes in Hospitalized Patients.

Abstract

Background: Current recommendations for limiting hypernatremia correction rates to avoid cerebral edema in adults are supported by limited evidence. We explored the associations between rate of hypernatremia correction in hospitalized adults, in-hospital mortality, and discharge disposition.

Methods: Using a large, multicenter database, we analyzed 37,913 hospitalized adults with hypernatremia on admission. For the primary analysis, hypernatremia correction rates were categorized as slow (≤0.50 mEq/L/hour) or fast (>0.50 mEq/L/hour). Propensity score (PS) weighting and PS stratification were employed to adjust for confounders. In secondary analyses, results were stratified by initial sodium concentration, age, and initial estimated glomerular filtration rate. In a sensitivity analysis, correction rates were categorized as <0.40 mEq/L/hour, 0.40-0.60 mEq/L/hour, or >0.60 mEq/L/hour.

Results: Most (89%) patients experienced slow hypernatremia correction. In PS-weighted analyses, slow correction was associated with overall lower in-hospital mortality (adjusted odds ratio [aOR] 0.63, 95% confidence interval [CI] 0.59-0.67) but higher odds of discharge to hospice (aOR 1.57, 95% CI 1.38-1.78) or nursing facilities (aOR 1.60, 95% CI 1.52-1.69) than fast (reference) correction rates. After stratification by initial hypernatremia severity, age, and kidney function at admission, the associations between slow versus fast correction, in-hospital mortality, and discharge disposition were largely preserved without clear signals of effect modification by subgroup. When categorizing hypernatremia correction rates into three groups, <0.40 mEq/L/hour versus >0.60 mEq/L/hour (analogous to slow versus fast, respectively) continued to be independently associated with lower in-hospital mortality but higher rates of discharge to nursing facilities or hospice.

Conclusions: In this analysis, the rate of hypernatremia correction was independently associated with opposing effects on survival and a favorable discharge disposition. Our findings suggest that balancing the risks and benefits of different dysnatremia correction rates should consider not only mortality but also patient-centered outcomes such as discharge disposition.