Sodium evolution in hyponatraemia: a mixed effects model analysis of the Hyponatraemia Registry.

Autor:	Cukoski S; Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany.; Emergency Department, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany., Osterholt T; Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany.; Emergency Department, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany., Suárez V; Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany.; Emergency Department, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany., Hackl MJ; Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany.; Emergency Department, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany., Grundmann F; Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany., Burst V; Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany.; Emergency Department, Faculty of Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany., Möllenhoff K; Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany.; Institute of Applied Mathematics, Heinrich-Heine-University, 40225 Düsseldorf, Germany.
Jazyk:	angličtina
Zdroj:	European journal of endocrinology [Eur J Endocrinol] 2023 Jun 07; Vol. 188 (6), pp. 526-535.
DOI:	10.1093/ejendo/lvad062
Abstrakt:	Objective: Achieving recommended targets of sodium correction is challenging to physicians treating hyponatraemia. Plasma sodium has to be increased effectively, yet overcorrection must be prevented. This is often hampered by a high variability of responses to treatment. Here, we sought to delineate factors influencing sodium evolution. Design: We retrospectively analysed 3460 patients from the multinational Hyponatraemia Registry comprising a wide range of hyponatraemia aetiologies and treatment strategies. Methods: Multivariable linear mixed effects models were applied to identify predictors of plasma sodium evolution within the first 24 h of treatment. Results: Evolution of sodium levels over time showed a curvilinear pattern with steeper rise at earlier time points. Baseline sodium showed the most pronounced impact with an additional increment of 3.12 mEq/L for every 10 mEq/L initial sodium reduction. With sodium increments of 1.9 mEq/L and 1.4 mEq/L per 24 h, respectively, the entities hypovolaemic and thiazide-associated hyponatraemia were independent factors for sodium evolution. Therapeutic regimens using hypertonic saline (4.6 mEq/L/24 h), tolvaptan (3.4 mEq/L/24 h), or combination therapy (2.6 mEq/L/24 h) were also associated with a significantly larger sodium rise when compared with no active treatment. Conclusions: Choice and dosing of active hyponatraemia therapy should be adjusted not only according to aetiology but most importantly to pretreatment sodium. Although counterintuitive, less aggressive therapy in more profound hyponatraemia might be safer but yet effective at least in less severe cases. Competing Interests: Conflicts of interest: V.B. is a consultant and his institution received research support from Otsuka for the Hyponatraemia Registry. He received travel support and fees for data review activities and served on a speakers’ bureau and advisory board panellist for Otsuka. F.G. and her institution received research support from Otsuka for participating in the Hyponatraemia Registry. All other authors declared no competing interests. (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Endocrinology.)
Databáze:	MEDLINE
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