ECE2020 Oral Communications Pituitary and Neuroendocrinology (7 abstracts)
Fluid restriction results in a modest rise in plasma sodium concentration in chronic hyponatraemia due to SIAD; results of a prospective randomised controlled trial
Aoife Garrahy 1 , Iona Galloway 1 , Anne Marie Hannon 1 , Rosemary Dineen 1 , Patrick O’Kelly 1 , William Tormey 2 , Michael O’Reilly 1 , David Williams 3 , Mark Sherlock 1 & Chris Thompson 1
1Academic Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland; 2Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland; 3Department of Stroke and Geriatric Medicine, Beaumont Hospital and RCSI Medical School, Dublin, Ireland
Fluid restriction (FR) is the recommended first-line treatment for chronic hyponatraemia due to syndrome of inappropriate antidiuresis (SIAD) in expert guidelines, despite the lack of prospective data to support its efficacy. We aimed to test the hypothesis that FR was more effective than no treatment. 46 patients with chronic SIAD were randomised to either fluid restriction (1 litre/day, FR) or no specific hyponatraemia treatment (NoTx) for one month. Inclusion criteria were euvolemia, plasma sodium (pNa) 120–130 mmol/l, urinary sodium (UNa) ≥30 mmol/l, urine osmolality (UOsm) $100 mOsm/kg and normal cortisol secretion. Patients with symptomatic hyponatraemia, alcohol dependence, diuretic therapy, and recent discontinuation of medications causing hyponatraemia, were excluded. The primary endpoints were change in pNa at day 4 and day 30, chosen to match the endpoints reported in the SALT trials. A rise in pNa of < 5 mmol/l was defined as treatment failure. Data are expressed as median (IQR). The two groups were matched for age (74 yrs (68–80) in FR and 72 yrs (54–80) in NoTx, P = 0.55), baseline pNa (127 (126–129) mmol/l FR and 128 (126–129) mmol/l NoTx, P = 0.36) and urine osmolality (459 (345–604) mOsm/kg FR and 457 (287–556) mOsm/kg NoTx, P = 0.86). Idiopathic SIAD accounted for 39% of FR, and 26% of NoTx, P = 0.15. PNa rose by 3 (2–4) mmol/l by day 4 in FR (n = 23), compared with 1 (0–3) mmol/l NoTx (n = 23), P = 0.005. There was minimal additional rise in pNa by day 30; pNa increased from baseline by 4 (2–6) mmol/l in FR (n = 17), compared with 1 (0–1) mmol/l NoTx (n = 15), P = 0.04. By day 4, 17% of FR had a rise in pNa of ≥5 mmol/l, compared with only 4% NoTx, P = 0.35. By day 30, 47% of FR had a rise in pNa of $5 mmol/l, compared with only 6.7% NoTx, RR 7.1, P = 0.02. There was no statistically significant difference in the proportion of patients reaching pNa $130 mmol/l by day 4, 61% FR compared with 39% NoTx, P = 0.24, or by day 30, 71% FR and 40% NoTx, P = 0.15. FR results in a modest rise in pNa after three days in patients with chronic SIAD, with minimal additional rise thereafter. Less than half of patients achieve a target rise in pNa ≥5 mmol/l after 30 days of FR, emphasising the clinical need for additional therapies for SIAD.
Volume 70
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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