Hyponatremia in cancer patients: Time for a new approach

Berardi, Rossana; Rinaldi, Silvia; Caramanti, Miriam; Grohé, Christian; Santoni, Matteo; Morgese, Francesca; Torniai, Mariangela; Savini, Agnese; Fiordoliva, Ilaria; Cascinu, Stefano

doi:10.1016/j.critrevonc.2016.03.010

Cited by 57 publications

(44 citation statements)

References 59 publications

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“…6 Syndrome of inappropriate antidiuresis may be the consequence of a paraneoplastic syndrome sustained by an ectopic production of ADH or it might be related to the presence of lung and central nervous system neoplastic localizations. 7 Also, many chemotherapeutic agents may cause SIAD through different mechanisms of action. For example, cyclophosphamide stimulates ADH secretion and potentiates the action of ADH in the kidneys, while vinca alkaloids have a neurotoxic effect on the hypothalamic-pituitary axis which alters normal osmotic control of ADH secretion.…”

Section: Introductionmentioning

confidence: 99%

Urea in cancer patients with chronic SIAD‐induced hyponatremia: Old drug, new evidence

Nervo

D’Angelo

Rosso

et al. 2019

Clinical Endocrinology

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Summary Background Syndrome of inappropriate antidiuresis (SIAD) is the main cause of hyponatremia in cancer patients. International guidelines indicate urea as an interesting option for chronic SIAD. Nevertheless, strong data to support its use are lacking, and its role in oncologic patients has not been described so far. Material and Methods We retrospectively analysed 36 cancer patients affected by moderate or profound SIAD‐induced chronic hyponatremia, who started oral urea (initial daily dose 15 g or 30 g) without fluid restriction between July 2013 and July 2018. We analysed mean serum sodium (sNa) increase after 24 hours and percentages of patients who reached eunatremia within 14, 30 and 60 days of treatment, stratifying according to the degree of hyponatremia at diagnosis. Clinical evaluation and biochemical assessment were periodically performed. Results Mean sNa was 123 [±4] mmol/L at baseline; after 24 hours of treatment, a mean increase of 5 [±3] mmol/L was observed. Eunatremia was reached by 55.6%, 86.1% and 91.7% patients within 14, 30 and 60 days of treatment, respectively. Trends in sNa normalization were similar in patients with moderate and profound hyponatremia at diagnosis. Rapid sNa overcorrection was avoided in all cases. Urea was interrupted within the first 2 months of treatment in 10 patients, in half cases for rapid neoplastic progression and in the remaining patients for the drug taste. Conclusions In our study, urea was effective in correcting chronic hyponatremia among cancer patients with SIAD. Almost all patients reached eunatremia within the first month of therapy, and urea was globally well tolerated.

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Section: Introductionmentioning

confidence: 99%

Urea in cancer patients with chronic SIAD‐induced hyponatremia: Old drug, new evidence

Nervo

D’Angelo

Rosso

et al. 2019

Clinical Endocrinology

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“…Diagnostic work-up is often viewed as complex, and treatment is considered cumbersome and potentially dangerous. However, despite the urgent need for better education on how to approach the hyponatremic patient [16], no evidence-based guideline for hyponatremia management specific to cancer patients is available. Current management strategies are not well characterized.…”

Section: Introductionmentioning

confidence: 99%

Euvolemic hyponatremia in cancer patients. Report of the Hyponatremia Registry: an observational multicenter international study

Burst

Grundmann

Kubacki

et al. 2017

Support Care Cancer

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PurposeHyponatremia secondary to SIADH is frequent in cancer patients and potentially deleterious. The aim of this sub-analysis of the Hyponatremia Registry database is to analyze current diagnostic and therapeutic management practices in cancer patients with SIADH.MethodsWe analyzed 358 cancer patients who had serum sodium concentration ([Na+]) ≤ 130 mEq/L and a clinical diagnosis of SIADH from 225 sites in the USA and EU.ResultsPrecise diagnostic testing was performed in only 46%. Almost 12% of all patients did not receive any hyponatremia treatment. The most frequent therapies were fluid restriction (20%), isotonic saline (14%), fluid restriction/isotonic saline (7%), tolvaptan (8%), and salt tablets (7%). Hypertonic saline was used in less than 3%. Tolvaptan produced the greatest median rate of [Na+] change (IQR) (3.0 (4.7) mEq/L/day), followed by hypertonic saline (2.0(7.0) mEq/L/day), and fluid restriction/isotonic saline (1.9(3.2) mEq/L/day). Both fluid restriction and isotonic saline monotherapies were significantly less effective (0.8(2.0) mEq/L/day and 1.3(3.0) mEq/L/day, respectively) and were associated with clinically relevant rates of treatment failure. Only 46% of patients were discharged with [Na+] ≥ 130 mEq/L. Overly rapid correction of hyponatremia occurred in 11.7%.ConclusionsAlthough essential for successful hyponatremia management, appropriate diagnostic testing is not routinely performed in current practice. The most frequently employed monotherapies were often ineffective and sometimes even aggravated hyponatremia. Tolvaptan was used less often but showed significantly greater effectiveness. Despite clear evidence that hyponatremia is associated with poor outcome in oncology patients, most patients were discharged still hyponatremic. Further studies are needed to assess the beneficial impact of hyponatremia correction with effective therapies.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-017-3638-3) contains supplementary material, which is available to authorized users.

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“…18) In the context, hyponatremia causes various symptoms, such as headache, convulsion, nausea, and vomiting. 19) The results of the present study indicate that the low Na ＋ group had a higher incidence of CINV events than the high Na ＋ group, and there was no signiˆcant diŠer-ence in the proportion of CINV events between chemotherapy regimens, nor was there a diŠerence with or without NK 1 receptor antagonist, which highlights the possibility that cancer patients with low serum sodium concentrations have an elevated risk of developing nausea and vomiting. Based on the heterogeneity in the low Na ＋ group, we performed a subanalysis which revealed that patients with hyponatre-mia had a higher incidence of nausea than patients with non-hyponatremic serum sodium concentrations.…”

Section: Discussionmentioning

confidence: 56%

Effects of Serum Sodium Concentrations on Nausea and Vomiting after Moderately Emetogenic Chemotherapy

Hatakeyama

Suzuki²,

Abe³

et al. 2018

YAKUGAKU ZASSHI

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Chemotherapy-induced nausea and vomiting (CINV) is the most unbearable adverse eŠect of chemotherapy. The antiemesis guidelines of the National Comprehensive Cancer Network indicate that hyponatremia is a risk factor for CINV, although the relationship between the incidence of CINV and hyponatremia has not been su‹ciently studied. This two-center prospective observational study evaluated whether low serum sodium concentrations were a risk factor for CINV. The study included 34 patients who were scheduled to receiveˆrst-line carboplatin-or oxaliplatin-based chemotherapy for gynecological or colorectal cancers. Patient diaries were used to record the daily incidences of CINV events during a 5-day period. The patients were divided based on the median serum sodium concentration into a low Na ＋ group (＜141 mEq/L) and a high Na ＋ group (141 mEq/L). The incidences of delayed nausea were 27.8％ in the high Na ＋ group and 62.5％ in the low Na ＋ group ( p＝0.042), with complete control rates (no vomiting, rescue medication, or grade 2 nausea) of 77.8％ and 43.8％, respectively ( p＝0.042). The time to complete control failure in each group was analyzed using the Kaplan-Meier method, which revealed a signiˆcantly shorter time in the low Na ＋ group ( p＝0.03). Therefore, these results indicate that low serum sodium concentrations may increase the risk of CINV.

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Hyponatremia in cancer patients: Time for a new approach

Cited by 57 publications

References 59 publications

Urea in cancer patients with chronic SIAD‐induced hyponatremia: Old drug, new evidence

Urea in cancer patients with chronic SIAD‐induced hyponatremia: Old drug, new evidence

Euvolemic hyponatremia in cancer patients. Report of the Hyponatremia Registry: an observational multicenter international study

Effects of Serum Sodium Concentrations on Nausea and Vomiting after Moderately Emetogenic Chemotherapy

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