Faculty Collaboration Database

Rapidity of Correction of Hyponatremia Due to Syndrome of Inappropriate Secretion of Antidiuretic Hormone Following Tolvaptan. Am J Kidney Dis 2018 Jun;71(6):772-782

Date

02/27/2018

Pubmed ID

29478867

Pubmed Central ID

PMC5970971

DOI

10.1053/j.ajkd.2017.12.002

Scopus ID

2-s2.0-85042328498 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

BACKGROUND: Tolvaptan effectively corrects hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), but undesired overcorrection can occur. We hypothesized that pretherapy parameters can predict the rapidity of response to tolvaptan in SIADH.

STUDY DESIGN: Multicenter historical cohort study.

SETTING & PARTICIPANTS: Adults with SIADH or congestive heart failure (CHF) treated with tolvaptan for a serum sodium concentration ≤ 130 mEq/L at 5 US hospitals.

PREDICTORS: Demographic and laboratory parameters.

OUTCOMES: Rate of change in serum sodium concentration.

MEASUREMENTS: Spearman correlations, analysis of variance, and multivariable linear mixed-effects models.

RESULTS: 28 patients with SIADH and 39 patients with CHF treated with tolvaptan (mean baseline serum sodium, 120.6 and 122.4 mEq/L, respectively) were studied. Correction of serum sodium concentration > 12 mEq/L/d occurred in 25% of patients with SIADH compared to 3% of those with CHF (P<0.001). Among patients with SIADH, the increase in serum sodium over 24 hours was correlated with baseline serum sodium concentration (r=-0.78; P<0.001), serum urea nitrogen concentration (SUN; r=-0.76; P<0.001), and estimated glomerular filtration rate (r=0.58; P=0.01). Baseline serum sodium and SUN concentrations were identified as independent predictors of change in serum sodium concentration in multivariable analyses. When patients were grouped into 4 categories according to baseline serum sodium and SUN median values, those with both low baseline serum sodium (≤121 mEq/L) and low baseline SUN concentrations (≤10mg/dL) exhibited a significantly greater rate of increase in serum sodium concentration (mean 24-hour increase of 15.4 mEq/L) than the other 3 categories (P<0.05). Among patients with CHF, only baseline SUN concentration was identified as an independent predictor of change in serum sodium concentration over time.

LIMITATIONS: Lack of uniformity in serial serum sodium concentration determinations and documentation of water intake.

CONCLUSIONS: Baseline serum sodium and SUN values are predictive of the rapidity of hyponatremia correction following tolvaptan use in SIADH. We advise caution when dosing tolvaptan in patients with both low serum sodium and SUN concentrations.

Author List

Morris JH, Bohm NM, Nemecek BD, Crawford R, Kelley D, Bhasin B, Nietert PJ, Velez JCQ

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Antidiuretic Hormone Receptor Antagonists
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Heart Failure
Humans
Hyponatremia
Inappropriate ADH Syndrome
Linear Models
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Severity of Illness Index
Sodium
Treatment Outcome