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

Abstract

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.

Intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella: A case report

“…Sood L et al [ 41 ] even proposed the use of hypertonic saline in conjunction with desmopressin as a protocol to predict and control the rate of sodium correction. [ 42 , 43 ] In hyponatremic patients with combined craniosynostosis where salt and fluid therapy is difficult, salt corticosteroids (fludrocortisone) may be recommended to increase renal tubular sodium reabsorption; however, we are unavailable because it is not yet approved for marketing in China. Shen et al [ 44 ] reported 4 patients with refractory hyponatremia complicated with SIAD and CSWS after TBI, and a triple regimen of intravenous rehydration, hydrocortisone, and tachyphylaxis resulted in normalization of serum sodium.…”

Tolvaptan for the treatment of the syndrome of inappropriate antidiuresis (SIAD)

“… 56 Finally, the most recent guidance, published in 2022 by the South Korean Society of Nephrology , also recommends tolvaptan as second-line therapy for hyponatraemia due to SIAD. 57 …”

“…With the exception of the European guidelines, 43 all other published recommendations and consensus statements 18 , 47 , 55 – 57 recommend tolvaptan as a second-line treatment option for SIAD in patients who do not respond to fluid restriction. Tolvaptan may also be used as a first-line agent in SIAD patients who are unlikely to respond to fluid restriction due to very limited renal excretion of solute-free water.…”

Recent updates in therapeutic approach using tolvaptan for autosomal dominant polycystic kidney disease

“…Arginine vasopressin (AVP) plays a pivotal role in maintaining fluid homeostasis in the body [6,7]. The level of circulating AVP is increased in patients with ADPKD, and the concentration of copeptin, a surrogate marker of vasopressin, is associated with disease severity [5,8].…”