ECE2017 Guided Posters Pituitary (12 abstracts)
Correction of sustained hyponatremia secondary to SIAD by the use of chronic tolvaptan therapy is associated with a reduction in Emergency Room visits, hospital admissions and days of hospitalization over a 3-year period
Martín Cuesta Hernández 1 , Irene Crespo Hernández 1 , Pablo Amich Alemany 1 , Emilia Gómez Hoyos 2 , Nancy Sánchez Gómez 3 , Alejandro Santiago 1 , Paz De Miguel Novoa 1 , Alfonso Luis Calle-Pascual 1 & Isabelle Runkle de la Vega 1
1Hospital Universitario Clínico San Carlos, Madrid, Spain; 2Hospital Universitario Clínico Universitario de Valladolid, Valladolid, Spain; 3Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Introduction: Hyponatremia (HN) is associated with worse clinical outcomes, and longer hospital lengths-of-stay than seen in eunatremic patients. The Syndrome of Inappropriate Antidiuresis (SIAD) is the most common cause of hyponatremia in hospitalization. We studied the relationship between correction of sustained SIAD-induced hyponatremia and visits to the Emergency Room (ERv) as well as hospital admissions (HA) in a case series.
Methods: Retrospective, cross-sectional study of patients whose HN was corrected with chronic tolvaptan therapy (CTV) for a minimum of 3 years. Serum Sodium levels(SNa) in mmol/l. Descriptive statistics expressed as median (IQR). SPSS 15, non-parametric tests (Wilcoxon for paired data), univariate analysis.
Results: 16/25(64%) patients fulfilled inclusion criteria. Nine patients not completing 1 year of follow-up were excluded. Median age: 82 (74–87). Women: 11/16(69%). HN was first detected a median of 51 months (IQR 29–56) prior to initiation of therapy. SIAD etiology: 9/16(56%) idiopathic, 3/16 (19%) drug-induced (19%), 2/16 (3%) respiratory, 1/16 (6%) abdominal, 1/16 (6%) cancer. The year before HN correction, Nadir SNa:120(115–125) mmol/l, with a median of 2(1–4) ERv/patient, HA:1(1–2) with 18(10–32) days of hospitalization (DH). During year 1 of CTV, Nadir SNa rose to 136(133–137) mmol/l (P=0.001), ERv dropped to 1(0-3)(P=0.03), HA to 0(0-0)(P=0.003), DH to 0(0,0)(P<0.001). The benefits were sustained when comparing the second and third years to the year prior to HN correction. Second year: ERv: 0(0-1)(P=0.004), HA: 0(0-1)(P=0.001), DH: 0(0-1)(P<0.001). Third year: ERv: 1(0-2)(P=0.05), HA: 0(0-1)(P=0.009), DH: 0(0-4)(P=0.01). Three years before start of therapy vs 3 years post: Total median ERv/patient: 3(1-5), HA: 2(1-4), DH 18(10-34) vs total ERv: 2(1-4) (P=0.03), HA: 1(0-2)(P=0.006), DH 0(0-4)(P=0.006). No patient developed hypernatremia. Tolvaptan doses were lowered if thirst developed or SNa reached 141 mmol/l. Final weekly TV dose was 34 mg (23–105).
Conclusions: Correction of sustained hyponatremia secondary to SIADH with chronic TV therapy was safe, and associated with a significant and sustained reduction in ER visits, hospital admissions, and days of hospitalization.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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