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ABSTRACT
Introduction: Hyponatremia is a frequent yet under-appreciated complication in chronic kidney disease (CKD). Its presence is associated with adverse clinical outcome or mortality, with lacked data on its prevalence and diagnostic evaluation among patients with CKD in Ghana. This study assessed the diagnostic utility of urine biomarkers in evaluating hyponatremia among patients with CKD.
Methods: A cross-sectional study was conducted at the renal clinic of Komfo Anokye Teaching Hospital between February and March 2025, involving 180 systematically sampled non-dialysis CKD stage 3–5 patients aged 18–80 years. Demographic, clinical and laboratory data were collected. Statistical analyses included t-tests, Chi-square, Mann-Whitney U, logistic regression, Pearson’s correlation, and Receive Operating Characteristics (ROC) curves (p<0.05).
Results: Hyponatremia occurred in 31 patients (17.2%), increasing with CKD severity: stage 3 (11.4%), stage 4 (16.7%), stage 5 (26.4%) (p=0.032); 87.1% were mild. Independent predictors were Diabetes mellitus (95% CI: 1.02–5.38, p=0.044), Heart failure (95% CI:1.42–7.59, p=0.005), NSAIDs (95% CI: 1.07–6.38, p=0.035), Herbal preparation(95% CI:1.03–4.36, p=0.041), eGFR <60 (95% CI: 0.92–0.98, p=0.003), lower urine sodium (95% CI:1.05–1.40, p=0.010), and lower urine osmolality(95% CI:1.11–1.62, p=0.002). Serum sodium weakly correlated with urine sodium, urine osmolality, and eGFR (r=0.079 vs 0.137 vs 0.105). Urine sodium strongly correlated with urine osmolality (r=0.869). Urine Osmolality <185 mOsm/kg outperformed urine sodium <40 mmol/L (AUC=0.902 vs 0.793). Combined use enhanced diagnostic accuracy.
Conclusion: Hyponatremia is common in advanced CKD. Routine screening and urine biomarker assessment enable early detection and targeted intervention, crucial for improving outcomes in resource-limited settings.