Management of euvolemic hyponatremia attributed to SIADH in the hospital: interim results from a prospective, observational, multi-center, global registry

Alessandro Peri; Joseph Verbalis; Arthur Greenberg; Gudmundur Johannsson; Steven Ball; Jens Otto Jorgensen; Joseph Chiodo

doi:10.1530/endoabs.32.OC1.6

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Endocrine Abstracts (2013) 32 OC1.6 | DOI: 10.1530/endoabs.32.OC1.6

ECE2013 Oral Communications Pituitary & Molecular Endocrinology (6 abstracts)

Management of euvolemic hyponatremia attributed to SIADH in the hospital: interim results from a prospective, observational, multi-center, global registry

Alessandro Peri ¹ , Joseph Verbalis ² , Arthur Greenberg ³ , Gudmundur Johannsson ⁴ , Steven Ball ⁵ , Jens Otto Jorgensen ⁶ & Joseph Chiodo ⁷

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¹University of Florence, Florence, Italy; ²Georgetown University, Washington, District of Columbia, USA; ³Duke University Medical Center, Durham, North Carolina, USA; ⁴University of Gothenburg, Gothenburg, Sweden; ⁵Newcastle University, Newcastle, UK; ⁶Aarhus University Hospital, Aarhus, Denmark, ⁷Otsuka America Pharmaceutical, Inc., Princeton, New Jersey, USA.

Introduction: Hyponatremia (HN) is the most common electrolyte disorder of hospitalized patients (pts). It occurs in up to 28% of in-pts, increases the in hospital risk of death by 1.47 fold, and is associated with significantly higher mortality risk following discharge. The HN Registry is the first large scale, international effort to document the clinical characteristics, treatments used, and impact of HN in hospital settings.

Methods: After informed consent or waiver, medical records of pts meeting the registry entry criteria were abstracted. Data are summarized by sample size (n) and percentage (%) for categorical data, and mean±S.D. for continuous data.

Results: One thousand seven hundred and six euvolemic pts with SIADH enrolled at 157 US and 93 EU sites from Sept 2010 to Dec 2012 had sufficient data for analysis. The mean entry and discharge [Na⁺] values for pts were 123.1±5.5 and 131.8±4.8 mmol/l. The table summarizes treatments given during hospitalization as treatment episodes of monotherapy (i.e. a treatment that was given alone during a discrete number of days).

Table 1
Treatment (Tx)*	During hospital stay (N)	Time to Tx from HN (days)	Duration of Tx (days)	(Na⁺) Correction rate (mmol/l per day)	(Na⁺) Increase >12 mmol/l within 24 h of Tx (%)
No treatment	17% (285)	NA	NA	1.1±1.3	2
Fluid restriction	56% (947)	1.70±3.2	5.64±5.7	1.4±2.0	1
Normal saline	51% (862)	0.75±2.1	2.67±2.4	2.0±2.8	2
Hypertonic saline	12% (212)	1.74±3.1	2.37±1.9	4.2±4.0	11
Tolvaptan	17% (292)	3.44±4.9	3.66±5.0	5.2±4.6	7
*pts could have >1 treatment episode per hospitalization.

Conclusions: Fluid Restriction was minimally more effective than no treatment. Tolvaptan and hypertonic saline had the highest correction rates, but the latter was associated with a greater risk of overly rapid correction. More data is needed in this area to inform optimal clinical practice, which will be forthcoming from continuing analysis of the HN Registry.