We read with interest the systematic review and meta-analysis by Vilaca et al.1 The authors mentioned several factors that could contribute to the increase in risk for hip and nonvertebral fractures in chronic kidney disease (CKD), such as low bone mineral density, CKD mineral and bone disorder, previous inflammation, glucocorticoid treatment, and diabetes mellitus, although none of these factors were analyzed in the meta-analysis. We suggest adding chronic hyponatremia as a novel risk factor for fractures in CKD patients, as it is a very frequent electrolyte abnormality in this population.