Hyponatremia is one of the most common water–electrolyte imbalances in the human organism. A serum sodium concentration threshold of less than 135 mmol/L is diagnostic for hyponatremia. The disorder is usually secondary to various diseases, including infections. Our review aims to summarize the diagnostic value and impact of hyponatremia on the prognosis, length of the hospitalization, and mortality among patients with active infection. The scientific literature regarding hyponatremia was reviewed using PubMed, ClinicalKey, and Web of Science databases. Studies published between 2011 and 2020 were screened and eligible studies were selected according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and specific inclusion criteria. The most common infections that were associated with hyponatremia were viral and bacterial infections, including COVID-19 (coronavirus disease 2019). The etiology varied according to the infection site, setting and patient cohort it concerned. In several studies, hyponatremia was associated with prolonged hospitalization, worse outcomes, and higher mortality rates. Hyponatremia can also play a diagnostic role in differentiating pathogens that cause a certain infection type, as it was observed in community-acquired pneumonia. Although many mechanisms leading to hyponatremia have already been described, it is impossible with any certainty to ascribe the etiology of hyponatremia to any of them.

This study is a post-hoc analysis of a previously published observational study. The aim is to characterize the epidemiology, etiology and antibiotic practices in KTRs admitted due to urosepsis (US) and urinary tract infection (UTI) to a tertiary transplantation center between the period 2014–2019.The two study groups consisted of 101 KTRs with a primary episode of US and 100 randomly selected KTRs hospitalized for UTI as a control group. A post-hoc analysis of clinical and microbiological data was performed, and a local microbiological map was created.The estimated yearly incidence of US in the study population was 21.1 (95% CI: 15.3–26.9) cases per 1000 KTRs per year. Urosepsis accounted for 85% of all sepsis cases. The most common causative pathogen in both groups was Escherichia coli. In 46% and 11% of US and UTI cases, initial empiric antibiotic therapy had to be escalated until day 3 due to lack of clinical response or proven bacterial resistance. This delay in appropriate antibiotic treatment in the US group was significantly associated with mortality (OR = 10.1 with p = 0.021), need for acute renal replacement therapy (OR = 4.73 with p = 0.012) and non-recovery from AKI (OR = 3.18 with p = 0.031). After discharge from hospital, almost 60% of all study subjects received a prophylactic antibiotic course for prevention of UTI recurrence, which did not translate into a lower frequency of readmission due to UTI in a multivariable analysis.US is a common insult that contributes to graft failure in KTRs. We recommend adjusting US and UTI treatments to center-specific microbiological maps in order to optimize treatment outcomes, reduce development of antibiotic resistance, and avoid unnecessary exposure to nephrotoxic antimicrobial drugs.

Background: Kidney transplant recipients (KTRs) are prone to development of muscle dysfunction and frailty. This study aimed to assess muscle strength and body composition alterations in KTRs, and whether an arteriovenous fistula (AVF) can influence handgrip strength (HGS) results in KTRs. Methods: One hundred fifty-six KTRs were recruited for the prospective, observational study. Both HGS tests and Timed Up and Go test were carried out. HGS results were analyzed taking into consideration the localization of AVF and hand domination. Results: Impaired mobility was identified in 34% of KTRs, while frailty was suspected in almost 13%. HGS differed in patients with an AVF on dominant arm, and equaled 29.5 (20–42), as compared to patients with no AVF on dominant arm with HGS 38 (28–48), p = 0.044. Conclusions: Impaired mobility is a common problem in the KTR population. The presence of an AVF influences HGS results. The diagnosis of frailty based on Fried criteria may not be valid in KTRs with an AVF, irrespective of its patency. Clinical Trial Registration number: NCT04478968, https://clinicaltrials.gov/search?term=NCT04478968