Interventions for chronic non-hypovolaemic hypotonic hyponatraemia

Nagler, Evi; Haller, Maria; Biesen, Wim Van; Vanholder, Raymond; Craig, Jonathan C.; Webster, Angela C

doi:10.1002/14651858.cd010965

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…The role of vasopressin V2 receptor antagonists (vaptans) to improve hyponatremia and, thereby, mortality have produced discordant results [26]. A Cochrane analysis done on studies done up to 2017 suggested that there is no role for vaptans in chronic (defined as >48 h) hypervolemic hyponatremia as they could not find a consistent benefit in reducing mortality with vaptans [27]. However, the study population in those studies were vastly different from the sicker hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

Thuluvath

Alukal

Zhang

2022

European Journal of Gastroenterology &Amp; Hepatology

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Background and objective Hypervolemic hyponatremia is a late complication of portal hypertension. Hyponatremia is associated with a higher mortality in hospitalized patients. In this study, we evaluated the risk factors for inhospital mortality and developed a mortality prediction model in patients with cirrhosis and hyponatremia. Methods Using the national inpatient sample data for years 2016 and 2017, we identified cirrhotic patients hospitalized with ascites and hyponatremia (n = 9153). We identified independent risk factors of inhospital mortality and developed a prediction model in a training group and assessed its accuracy in a validation group. To enhance the clinical utility, we further stratified patients into low-, intermediate-, and high-risk mortality risk groups using cutoff points selected by decision tree analysis. Results The inhospital mortality in our cohort was 10.2% (n = 846). Multivariable analysis showed that age at least 65 years, variceal bleeding, sepsis, coagulopathy, and acute-on-chronic liver failure (ACLF defined as two or more organ failures) were independent risk factors for mortality. The prediction model using these five risk factors had an AUROC of 0.80 [95% confidence interval (CI), 0.78–0.82] for the training data and 0.83 (95% CI, 0.80–0.86) for the validation data. The mortality risks in the low-, intermediate-, and high-risk groups were 4% (95% CI, 3–4), 29% (95% CI, 28–33), and 43% (95% CI, 37–50), respectively. Conclusion We have developed a clinically meaningful inhospital prognostic model with excellent discrimination that will enable clinicians to risk stratify hospitalized patients with hyponatremia, ascites, and cirrhosis.

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Section: Discussionmentioning

confidence: 99%

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

Thuluvath

Alukal

Zhang

2022

European Journal of Gastroenterology &Amp; Hepatology

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“…Previous studies focused on short-term outcomes such as normalization of SNa or overcorrection. Few studies evaluated the effect of vaptans stratified by volume status: hypervolemia or euvolemia [35,36]. Aggravation of hyponatremia can cause severe symptoms such as poor oral intake, general weakness or altered consciousness, leading to hospitalization.…”

Section: Remarksmentioning

confidence: 99%

Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and management of hyponatremia

Lee¹,

Yoo²,

Baek³

et al. 2022

Korean J Intern Med

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The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.

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“…Since hyponatremia in heart failure primarily occurs due to derangements of free water regulation, limiting free water intake may help; the American College of Cardiology/American Heart Association and European heart failure guidelines explicitly recommend this strategy for patients with stage D heart failure 3 , 4 . However, no available randomized data support this practice, and observational data suggest that fluid restriction has limited impact on hyponatremia in ADHF 14 . Guidelines also suggest employing fluid restriction in patients with diuretic resistance as an adjunctive therapy.…”

Section: When Fluid Restriction Is Helpful In the Management Of Decompensated Heart Failure In Hfref Patientsmentioning

confidence: 99%

Things We Do for No Reason™: Fluid Restriction for the Management of Acute Decompensated Heart Failure in Patients With Reduced Ejection Fraction

Caton

Jimenez

Wang

2021

Journal of Hospital Medicine

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Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason ™ " (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

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Interventions for chronic non-hypovolaemic hypotonic hyponatraemia

Abstract: Interventions for chronic non-hypovolaemic hypotonic hyponatraemia.

Cited by 4 publications

References 15 publications

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and management of hyponatremia

Things We Do for No Reason™: Fluid Restriction for the Management of Acute Decompensated Heart Failure in Patients With Reduced Ejection Fraction

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