Current treatment practice and outcomes. Report of the hyponatremia registry

Arthur Greenberg, Joseph G. Verbalis, Alpesh N. Amin, Volker R. Burst, Joseph A. Chiodo, Jun R. Chiong, Joseph F. Dasta, Keith E. Friend, Paul Hauptman, Alessandro Peri, Samuel H. Sigal

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)167-177
Number of pages11
JournalKidney International
Volume88
Issue number1
DOIs
StatePublished - Jul 2 2015

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Hyponatremia
Registries
Sodium
Serum
Therapeutics
Practice Management
European Union
Logistic Models
tolvaptan

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

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 International, 88(1), 167-177. https://doi.org/10.1038/ki.2015.4

Current treatment practice and outcomes. Report of the hyponatremia registry. / Greenberg, Arthur; Verbalis, Joseph G.; Amin, Alpesh N.; Burst, Volker R.; Chiodo, Joseph A.; Chiong, Jun R.; Dasta, Joseph F.; Friend, Keith E.; Hauptman, Paul; Peri, Alessandro; Sigal, Samuel H.

In: Kidney International, Vol. 88, No. 1, 02.07.2015, p. 167-177.

Research output: Contribution to journalArticle

Greenberg, A, Verbalis, JG, Amin, AN, Burst, VR, Chiodo, JA, Chiong, JR, Dasta, JF, Friend, KE, Hauptman, P, Peri, A & Sigal, SH 2015, 'Current treatment practice and outcomes. Report of the hyponatremia registry', Kidney International, vol. 88, no. 1, pp. 167-177. 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 International. 2015 Jul 2;88(1):167-177. https://doi.org/10.1038/ki.2015.4
Greenberg, Arthur ; Verbalis, Joseph G. ; Amin, Alpesh N. ; Burst, Volker R. ; Chiodo, Joseph A. ; Chiong, Jun R. ; Dasta, Joseph F. ; Friend, Keith E. ; Hauptman, Paul ; Peri, Alessandro ; Sigal, Samuel H. / Current treatment practice and outcomes. Report of the hyponatremia registry. In: Kidney International. 2015 ; Vol. 88, No. 1. pp. 167-177.
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