Table 3.
Effectiveness and overcorrection of HN therapy options in TAH and SIADH patients
| TAH | Patients, n | Median baseline [Na+] (IQR), mEq/L | Median rate of [Na+] change, (IQR), mEq/L/days | [Na+] change (IQR) in first 24 h, mEq/L | Median duration of Rx (IQR), days | Overly rapid correction, n (%) |
|---|---|---|---|---|---|---|
| All therapies | ||||||
| TAH overall | 457 | 122 (10) | 3.0 (4.2) | 4.0 (7.0) | 2 (3) | 14 (3.1) |
| Immediate withdrawal | 259 | 120 (9) | 3.8 (4.0) | 6.0 (6.0) | 2 (2) | 12 (4.6) |
| Delayed or no withdrawal | 198 | 126 (8) | 1.7 (3.8) | 3.0 (6.0) | 3 (4) | 2 (1.0) |
| SIADH | 1,524 | 123 (9) | 1.5 (3.6) | 3.0 (5.2) | 2 (3) | 155 (10.2) |
| No active therapy | ||||||
| TAH overall | 76 | 128 (5) | 0.6 (2.1) | 2.0 (4.3) | 4 (3) | 1 (1.3) |
| Immediate withdrawal | 29 | 124 (7) | 2.0 (4.0) | 3.0 (9.0) | 4 (2) | 1 (3.4) |
| Delayed or no withdrawal | 47 | 129 (3) | 0.4 (1.0) | 1.0 (4.0) | 5 (3) | 0 |
| SIADH | 170 | 127 (5) | 0.4 (1.0) | 2.0 (4.5) | 7 (8) | 4 (2.4) |
| Isotonic saline | ||||||
| TAH overall | 136 | 122 (10) | 3.1 (3.8) | 5.0 (6.0) | 2 (2) | 5 (3.7) |
| Immediate withdrawal | 79 | 121 (9) | 3.6 (3.5) | 6.0 (6.0) | 2 (2) | 4 (5.1) |
| Delayed or no withdrawal | 57 | 124 (10) | 2.0 (4.7) | 4.0 (6.0) | 2 (2) | 1 (1.8) |
| SIADH | 343 | 123 (8) | 1.5 (3.6) | 2.0 (5.0) | 1 (1) | 22 (6.4) |
| Fluid restriction | ||||||
| TAH overall | 93 | 121 (8) | 2.3 (3.3) | 2.0 (6.0) | 3 (2) | 0 |
| Immediate withdrawal | 53 | 120 (8) | 2.7 (2.7) | 3.5 (6.0) | 3 (2) | 0 |
| Delayed or no withdrawal | 40 | 122 (6) | 1.9 (2.9) | 2.0 (7.0) | 3 (3) | 0 |
| SIADH | 393 | 123 (7) | 1.0 (2.2) | 2.0 (5.0) | 3 (5) | 30 (7.6) |
| FR + NS | ||||||
| TAH overall | 39 | 120 (5) | 4.5 (5.2) | 5.0 (8.0) | 1 (1) | 1 (2.6) |
| Immediate withdrawal | 28 | 120 (5) | 4.5 (3.8) | 5.5 (7.3) | 1 (1) | 1 (3.6) |
| Delayed or no withdrawal | 11 | 120 (5) | 5.0 (6.0) | 4.0 (7.0) | 1 (0) | 0 |
| SIADH | 112 | 121 (7) | 2.4 (3.6) | 2.0 (5.0) | 2 (1) | 16 (14.3) |
| Hypertonic saline | ||||||
| TAH overall | 23 | 117 (7) | 5.3 (6.8) | 8.0 (6.0) | 1 (3) | 4 (17.4) |
| Immediate withdrawal | 14 | 115 (6) | 8.0 (6.4) | 11.0 (4.8) | 1 (2) | 3 (21.4) |
| Delayed or no withdrawal | 9 | 121 (7) | 4.3 (3.5) | 5.0 (2.0) | 3 (5) | 1 (11.1) |
| SIADH | 49 | 120 (8) | 3.1 (6.3) | 5.0 (8.5) | 2 (2.5) | 11 (17.4) |
| Tolvaptan | ||||||
| TAH overall (individual values) | 4 | |||||
| Immediate withdrawal | 2 | 128, 129 | 8.0, 0.5 | 8.0, 1.0 | 1, 4 | 0 (0) |
| Delayed or no withdrawal | 2 | 114, 125 | 8.0, 4.0 | 8.0, 8.0 | 1, 2 | 0 (0) |
| SIADH | 83 | 125 (8) | 4.3 (7.4) | 7.0 (10.0) | 1 (2) | 21 (25.3) |
p-values <0.05 for comparison of TAH (overall) vs. SIADH group with each therapy: All therapies: Baseline [Na+] (BL), Δdaily[Na+], Δ24h[Na+], overly rapid correction. No active therapy: duration. Isotonic saline: [Na+] (BL), Δdaily[Na+], Δ24h[Na+], duration. Fluid restriction: Δdaily[Na+]. FR + NS: Δdaily[Na+], Δ24h[Na+]. p values <0.05 for comparison of immediate vs. delayed/no thiazide withdrawal in the TAH group: All therapies: BL, Δdaily[Na+], Δ24h[Na+], duration, overly rapid correction. No active therapy: BL, Δdaily[Na+], Δ24h[Na+], duration. Isotonic saline: BL, Δdaily[Na+], Δ24h[Na+]. Fluid restriction: BL, Δ24h[Na+]. Hypertonic saline: BL, Δdaily[Na+], Δ24h[Na+]. p values <0.05 for comparison of the various active therapies in TAH (overall) group: BL: No active treatment vs. all other therapies; NS vs. HS; FR vs. HS; FR + NS vs. HS. Δdaily[Na+]: No active treatment vs. all other therapies; NS vs. FR, FR + NS, HS; FR vs. FR + NS, HS. Δ24h[Na+]: No active treatment vs. NS, HS, FR + NS; NS vs. FS HS; FR vs. FR + NS, HS; FR + NS vs. HS. Duration: No active treatment vs. all other therapies; NS vs. FR, FR + NS; FR vs. FR + NS. Overly rapid correction: not tested due to low numbers. IQR, interquartile range; TAH, thiazide-associated hyponatremia; SIADH, syndrome of inappropriate antidiuretic hormone secretion.