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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Nephrol
2017 ; 45
(5
): 420-430
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Thiazide-Associated Hyponatremia, Report of the Hyponatremia Registry: An
Observational Multicenter International Study
#MMPMID28419981
Burst V
; Grundmann F
; Kubacki T
; Greenberg A
; Becker I
; Rudolf D
; Verbalis J
Am J Nephrol
2017[]; 45
(5
): 420-430
PMID28419981
show ga
BACKGROUND: Hyponatremia is a frequent and potentially life-threatening adverse
side effect of thiazide diuretics. This sub-analysis of the Hyponatremia Registry
database focuses on current management practices of thiazide-associated
hyponatremia (TAH) and compares differences between TAH and syndrome of
inappropriate antidiuretic hormone secretion (SIADH). METHODS: We analyzed 477
patients from 225 US and EU sites with euvolemic hyponatremia ([Na+] ?130 mEq/L)
who were receiving a thiazide diuretic. Of these, 118 met criteria for true
thiazide-induced hyponatremia (TIH). RESULTS: Thiazide was withdrawn immediately
after hyponatremia was diagnosed only in 57% of TAH; in these patients, the
median rate of [Na+] change (?daily[Na+]) was significantly higher than those
with continued thiazide treatment (3.8 [interquartile range: 4.0] vs. 1.7 [3.8]
mEq/L/day). The most frequently employed therapies were isotonic saline (29.6%),
fluid restriction (19.9%), the combination of these two (8.2%), and hypertonic
saline (5.2%). Hypertonic saline produced the greatest ?daily[Na+] (8.0[6.4]
mEq/L/day) followed by a combination of fluid restriction and normal saline (4.5
[3.8] mEq/L/day) and normal saline alone (3.6 [3.5] mEq/L/day). Fluid restriction
was markedly less effective (2.7 [2.7] mEq/L/day). Overly rapid correction of
hyponatremia occurred in 3.1% overall, but in up to 21.4% given hypertonic
saline. Although there are highly significant differences in the biochemical
profiles between TIH and SIADH, no predictive diagnostic test could be derived.
CONCLUSIONS: Despite its high incidence and potential risks, the management of
TAH is often poor. Immediate withdrawal of the thiazide is crucial for treatment
success. Hypertonic saline is most effective in correcting hyponatremia but
associated with a high rate of overly rapid correction. We could not establish a
diagnostic laboratory-based test to differentiate TIH from SIADH.
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