ECE2015 Guided Posters Pituitary–Neuroendocrinology and central salt regulation (9 abstracts)
Predictors of response to fluid restriction in hyponatremic patients due to the syndrome of inappropriate antidiuresis
Sophia Lengsfeld 1, , Bettina Winzeler 1, , Nicole Nigro 1, , Isabelle Suter-Widmer 1, , Philipp Schütz 2, , Birsen Arici 1, , Martina Bally 2, , Claudine Blum 2, , Andreas Bock 4, , Andreas Huber 2, , Beat Müller 2, & Mirjam Christ-Crain 1,
1Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; 2Medical University Clinic, Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland; 3Division of Emergency Medicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; 4Department of Clinical Research, University Hospital Basel, Basel, Switzerland; 5Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland; 6Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Introduction: Fluid restriction (FR) is often the recommended first-line treatment for hyponatremia due to the syndrome of inappropriate antidiuresis (SIAD). However, FR not always leads to successful correction of hyponatremia, making predictive markers of treatment response desirable. The aim of this study was to evaluate routinely measured laboratory parameters, copeptin and pro-atrial natriuretic peptide (pro-ANP) as possible predictors of treatment success to FR.
Methods and design: We analysed 106 patients with SIAD out of 298 prospectively observed patients with profound hyponatremia (serum sodium <125 mmol/l). 82/106 patients with SIAD were initially treated with FR and included in this study. FR was defined as a total daily intake of <1000 ml. According to the change from baseline to follow-up serum sodium (within 24 h), we classified patients into FR responders (increase of >3 mmol/l) or FR non-responders (≤3 mmol/l). We performed regression models to look for correlations between different urine and serum parameters and treatment response.
Results: Of the 82 patients (mean age 67.6 years, 64.6% females) 48 (58.5%) responded to the initial trial of FR. Both baseline levels of urinary sodium and u-osmolality showed a significant correlation with treatment response (P for interaction=0.004 and P=0.041 respectively), whereat high levels indicate a FR failure. Initial serum sodium did not predict response to FR (P=0.26). Similarly, levels of copeptin – a surrogate marker of arginine vasopressin (AVP) – did not reveal a significant correlation with treatment success (P=0.68). Finally, we found a predictive value of pro-ANP; the higher pro-ANP levels the greater the likelihood of a positive response (P for interaction=0.004).
Conclusion: Easy measured urinary parameters and pro-ANP correlate with therapeutic success of fluid restriction and may enhance the management of patients with hyponatremia due to SIAD.
Disclosure: Thermo Scientific Biomarkers provided all the kits for measurement of Copeptin and MR-proANP analysis. P Schütz, B Müller, and M Christ-Crain have received speaker honoraria from Thermo Scientific Biomarkers. N Nigro was supported by a grant from the University Basel, Switzerland.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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