Hyponatremia Correction Rates and Mortality: Causality or Epiphenomenon?

Rondon-Berrios, Helbert; Sterns, Richard H.

doi:10.34067/kid.0000000000000414

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…Confounding by diagnosis has presented a critical shortcoming in prior analyses. 6 Conceptually, it can be understood by considering that patients with certain diagnoses, such as decompensated liver disease, may present in a critically ill state that portends a prolonged hospitalization, and it may not be safe or physiologically possible to rapidly correct their sodium values. 17 Meanwhile patients presenting with more readily reversible conditions that do not portend a prolonged admission may also be clinically better candidates for rapid sodium correction.…”

Section: Discussionmentioning

confidence: 99%

“…While these and other findings could be practice-changing, it is important to recognize that the studies did not directly account for admission diagnosis, leaving open the potential for significant confounding. This is a known concern with numerous prior studies, leading the authors of one recent review article to question whether reported associations between correction rates and mortality are “causality or epiphenomenon.” 6…”

Section: Introductionmentioning

confidence: 99%

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A Reassessment of Sodium Correction Rates and Hospital Length of Stay Accounting for Admission Diagnosis

Gottlieb,

Celi

2024

Preprint

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Background Recent studies have challenged assumptions about slow correction of severe hyponatremia and have shown that rapid correction is associated with shorter hospital length of stay. However, the confounding effect of admission diagnosis has not been fully explored. The objective of this study was to determine whether rapid correction is still associated with shorter length of stay when controlling for admission diagnosis. Methods This retrospective cohort study is based on the Medical Information Mart for Intensive Care, including data from both MIMIC-III (2001-2012) and MIMIC-IV (2008-2019). Patients were identified who presented to the hospital with initial sodium <120 mEq/L and were categorized according to total sodium correction achieved in the first day (<6 mEq/L; 6-10 mEq/L; >10 mEq/L). Linear regression was used to assess for an association between correction rate and hospital length of stay, and to determine if this association was significant when controlling for admission diagnosis classifications based on diagnosis related groups (DRGs). Results There were 636 patients included in this study. Median [IQR] hospital length of stay was 7 [4, 11] days. Patients had a median [IQR] initial sodium value of 117 [114, 118] mEq/L and final sodium value of 124 [119, 128] mEq/L. In a univariate linear regression, the highest rate of correction (>10 mEq/L) was associated with a shorter length of stay than a moderate rate of correction (coef. -2.363, 95% CI [-4.710, -0.017], p=0.048), but the association was not significant when controlling for admission diagnosis group (coef. -1.685, 95% CI [-3.836, 0.467], p=0.125). Conclusions Faster sodium correction was not associated with shorter length of stay when controlling for admission diagnosis categories, suggesting that the disease state confounds this association. While some patients may be discharged earlier if sodium is corrected more rapidly, others may not benefit or may be harmed by this strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Reassessment of Sodium Correction Rates and Hospital Length of Stay Accounting for Admission Diagnosis

Gottlieb,

Celi

2024

Preprint

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Syndrome of Inappropriate Antidiuresis

Rosner,

Rondon-Berrios,

Sterns

2024

JASN

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The syndrome of inappropriate antidiuresis (SIAD)–the most frequent cause of hypotonic hyponatremia–is mediated by nonosmotic release of arginine vasopressin (AVP), which promotes water retention by activating renal vasopressin type 2 (V2) receptors. There are numerous causes of SIAD, including malignancy, pulmonary and central nervous system diseases and medications. Rare activating mutations of the V2 receptor can also cause SIAD Determination of the etiology of SIAD is important because removal of the stimulus for inappropriate AVP secretion offers the most effective therapy. Treatment of SIAD is guided by symptoms and their severity as well as the level of plasma sodium. In the absence of severe symptoms which require urgent intervention, many clinicians focus on fluid restriction as a first-line treatment. Second-line therapeutic options include loop diuretics and salt tablets, urea, and V2 receptor antagonists.

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Hyponatremia Correction Rates and Mortality: Causality or Epiphenomenon?

Cited by 2 publications

References 10 publications

A Reassessment of Sodium Correction Rates and Hospital Length of Stay Accounting for Admission Diagnosis

A Reassessment of Sodium Correction Rates and Hospital Length of Stay Accounting for Admission Diagnosis

Syndrome of Inappropriate Antidiuresis

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