Burst Volker, Grundmann Franziska, Kubacki Torsten, Greenberg Arthur, Rudolf Despina, Salahudeen Abdulla, Verbalis Joseph, Grohé Christian
Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Duke University Medical Center, Durham, NC, USA.
Support Care Cancer. 2017 Jul;25(7):2275-2283. doi: 10.1007/s00520-017-3638-3. Epub 2017 Mar 2.
Hyponatremia secondary to SIADH is frequent in cancer patients and potentially deleterious. The aim of this sub-analysis of the Hyponatremia Registry database is to analyze current diagnostic and therapeutic management practices in cancer patients with SIADH.
We analyzed 358 cancer patients who had serum sodium concentration ([Na]) ≤ 130 mEq/L and a clinical diagnosis of SIADH from 225 sites in the USA and EU.
Precise diagnostic testing was performed in only 46%. Almost 12% of all patients did not receive any hyponatremia treatment. The most frequent therapies were fluid restriction (20%), isotonic saline (14%), fluid restriction/isotonic saline (7%), tolvaptan (8%), and salt tablets (7%). Hypertonic saline was used in less than 3%. Tolvaptan produced the greatest median rate of [Na] change (IQR) (3.0 (4.7) mEq/L/day), followed by hypertonic saline (2.0(7.0) mEq/L/day), and fluid restriction/isotonic saline (1.9(3.2) mEq/L/day). Both fluid restriction and isotonic saline monotherapies were significantly less effective (0.8(2.0) mEq/L/day and 1.3(3.0) mEq/L/day, respectively) and were associated with clinically relevant rates of treatment failure. Only 46% of patients were discharged with [Na] ≥ 130 mEq/L. Overly rapid correction of hyponatremia occurred in 11.7%.
Although essential for successful hyponatremia management, appropriate diagnostic testing is not routinely performed in current practice. The most frequently employed monotherapies were often ineffective and sometimes even aggravated hyponatremia. Tolvaptan was used less often but showed significantly greater effectiveness. Despite clear evidence that hyponatremia is associated with poor outcome in oncology patients, most patients were discharged still hyponatremic. Further studies are needed to assess the beneficial impact of hyponatremia correction with effective therapies.
抗利尿激素分泌异常综合征（SIADH）继发的低钠血症在癌症患者中很常见，且可能有害。对低钠血症注册数据库进行本次亚分析的目的是分析SIADH癌症患者当前的诊断和治疗管理实践。
我们分析了来自美国和欧盟225个地点的358例血清钠浓度（[Na]）≤130 mEq/L且临床诊断为SIADH的癌症患者。
仅46%的患者进行了精确的诊断检测。几乎12%的患者未接受任何低钠血症治疗。最常用的治疗方法是限液（20%）、等渗盐水（14%）、限液/等渗盐水（7%）、托伐普坦（8%）和盐片（7%）。高渗盐水的使用比例不到3%。托伐普坦使[Na]变化的中位数速率（IQR）最大（3.0（4.7）mEq/L/天），其次是高渗盐水（2.0（7.0）mEq/L/天）和限液/等渗盐水（1.9（3.2）mEq/L/天）。限液和等渗盐水单一疗法的效果均明显较差（分别为0.8（2.0）mEq/L/天和1.3（3.0）mEq/L/天），且与临床相关的治疗失败率相关。只有46%的患者出院时[Na]≥130 mEq/L。11.7%的患者出现低钠血症纠正过快的情况。
尽管适当的诊断检测对于成功管理低钠血症至关重要，但在当前实践中并未常规进行。最常用的单一疗法往往无效，有时甚至会加重低钠血症。托伐普坦使用频率较低，但效果明显更好。尽管有明确证据表明低钠血症与肿瘤患者的不良预后相关，但大多数患者出院时仍为低钠血症。需要进一步研究以评估有效治疗纠正低钠血症的有益影响。
