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Current treatment practice and outcomes. Report of the hyponatremia registry.

Publication ,  Journal Article
Greenberg, A; Verbalis, JG; Amin, AN; Burst, VR; Chiodo, JA; Chiong, JR; Dasta, JF; Friend, KE; Hauptman, PJ; Peri, A; Sigal, SH
Published in: Kidney Int
July 2015

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.

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Published In

Kidney Int

DOI

EISSN

1523-1755

Publication Date

July 2015

Volume

88

Issue

1

Start / End Page

167 / 177

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Tolvaptan
  • Sodium
  • Saline Solution, Hypertonic
  • Registries
  • Osmolar Concentration
  • Middle Aged
  • Male
  • Hyponatremia
 

Citation

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Greenberg, A., Verbalis, J. G., Amin, A. N., Burst, V. R., Chiodo, J. A., Chiong, J. R., … Sigal, S. H. (2015). Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int, 88(1), 167–177. https://doi.org/10.1038/ki.2015.4
Greenberg, Arthur, Joseph G. Verbalis, Alpesh N. Amin, Volker R. Burst, Joseph A. Chiodo, Jun R. Chiong, Joseph F. Dasta, et al. “Current treatment practice and outcomes. Report of the hyponatremia registry.Kidney Int 88, no. 1 (July 2015): 167–77. https://doi.org/10.1038/ki.2015.4.
Greenberg A, Verbalis JG, Amin AN, Burst VR, Chiodo JA, Chiong JR, et al. Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int. 2015 Jul;88(1):167–77.
Greenberg, Arthur, et al. “Current treatment practice and outcomes. Report of the hyponatremia registry.Kidney Int, vol. 88, no. 1, July 2015, pp. 167–77. Pubmed, doi:10.1038/ki.2015.4.
Greenberg A, Verbalis JG, Amin AN, Burst VR, Chiodo JA, Chiong JR, Dasta JF, Friend KE, Hauptman PJ, Peri A, Sigal SH. Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int. 2015 Jul;88(1):167–177.
Journal cover image

Published In

Kidney Int

DOI

EISSN

1523-1755

Publication Date

July 2015

Volume

88

Issue

1

Start / End Page

167 / 177

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Tolvaptan
  • Sodium
  • Saline Solution, Hypertonic
  • Registries
  • Osmolar Concentration
  • Middle Aged
  • Male
  • Hyponatremia