title: Current treatment practice and outcomes. Report of the hyponatremia registry.
abstract: Current management practices for hyponatremia (HN) are incompletely understood. The HN Registry has recorded diagnostic measures, utilization, efficacy, and outcomes of therapy for eu- or hypervolemic HN. To better understand current practices, we analyzed data from 3087 adjudicated adult patients in the registry with serum sodium concentration of 130 mEq/l or less from 225 sites in the United States and European Union. Common initial monotherapy treatments were fluid restriction (35%), administration of isotonic (15%) or hypertonic saline (2%), and tolvaptan (5%); 17% received no active agent. Median (interquartile range) mEq/l serum sodium increases during the first day were as follows: no treatment, 1.0 (0.0-4.0); fluid restriction, 2.0 (0.0-4.0); isotonic saline, 3.0 (0.0-5.0); hypertonic saline, 5.0 (1.0-9.0); and tolvaptan, 4.0 (2.0-9.0). Adjusting for initial serum sodium concentration with logistic regression, the relative likelihoods for correction by 5 mEq/l or more (referent, fluid restriction) were 1.60 for hypertonic saline and 2.55 for tolvaptan. At discharge, serum sodium concentration was under 135 mEq/l in 78% of patients and 130 mEq/l or less in 49%. Overly rapid correction occurred in 7.9%. Thus, initial HN treatment often uses maneuvers of limited efficacy. Despite an association with poor outcomes and availability of effective therapy, most patients with HN are discharged from hospital still hyponatremic. Studies to assess short- and long-term benefits of correction of HN with effective therapies are needed.
authors: Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors: Arthur
authors: A
authors: Greenberg
authors: Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.
authors: Joseph G
authors: JG
authors: Verbalis
authors: Department of Medicine, University of California, Irvine, California, USA.
authors: Alpesh N
authors: AN
authors: Amin
authors: Department II of Internal Medicine: Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Volker R
authors: VR
authors: Burst
authors: Otsuka America Pharmaceutical, Princeton, New Jersey, USA.
authors: Joseph A
authors: JA
authors: Chiodo
authors: Department of Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
authors: Jun R
authors: JR
authors: Chiong
authors: University of Texas College of Pharmacy, Austin, Texas, USA.
authors: Joseph F
authors: JF
authors: Dasta
authors: Otsuka America Pharmaceutical, Princeton, New Jersey, USA.
authors: Keith E
authors: KE
authors: Friend
authors: Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA.
authors: Paul J
authors: PJ
authors: Hauptman
authors: Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
authors: Alessandro
authors: A
authors: Peri
authors: Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center and School of Medicine, New York City, New York, USA.
authors: Samuel H
authors: SH
authors: Sigal
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012042:Registries; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012964:Sodium / Q000097:blood; D000077602:Tolvaptan; D016896:Treatment Outcome
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D012462:Saline Solution, Hypertonic; D000077602:Tolvaptan; D012964:Sodium