Department of Health Care and Endocrinology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China.
Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China.
Int J Clin Pract. 2021 Jun;75(6):e13939. doi: 10.1111/ijcp.13939. Epub 2020 Dec 31.
Serum sodium overcorrection and hypernatremia are significant health risks. We conducted a systematic review and meta-analysis to evaluate the risks of vaptans in hypernatremia and serum sodium overcorrection.
We searched PubMed, Embase, and CENTRAL for randomised controlled trials. We included studies comparing vaptans and placebo with data on hypernatremia and serum sodium overcorrection. The study quality was assessed using the Cochrane Collaboration's risk-of-bias assessment tool. Fixed-effect model meta-analysis was used to pool the data. Different analyses were performed to ensure the accuracy of the results.
Twenty-eight studies were included in the meta-analysis of hypernatremia incidence. Treatment with vaptans resulted in a higher risk of hypernatremia than placebo (3.8% vs 1.0%, odds ratio [OR] 2.69; 95% confidence interval [CI] 1.97-3.68). The subgroup with baseline hyponatremia had a lower risk of hypernatremia incidence; however, the use of loop diuretics increased the risk. Fourteen studies were included in the analysis of the incidence of serum sodium overcorrection. A higher risk of serum sodium overcorrection was found in using vaptans vs placebo (4.4% vs 1.4%; OR 2.26; 95% CI 1.32-3.86).
Vaptans showed higher risks in the incidence of hypernatremia and serum sodium overcorrection than placebo. In addition, combination with loop diuretics increased the risk of hypernatremia. The risk of serum sodium overcorrection should be concerned in patients with hyponatremia and normal serum sodium equally. Using a low dose of vaptans can reduce both risks.
血清钠校正过度和高钠血症是重大健康风险。我们进行了系统评价和荟萃分析，以评估 vaptans 在高钠血症和血清钠校正过度中的风险。
我们在 PubMed、Embase 和 CENTRAL 中搜索了随机对照试验。我们纳入了比较 vaptans 和安慰剂且有高钠血症和血清钠校正过度数据的研究。使用 Cochrane 协作风险偏倚评估工具评估研究质量。使用固定效应模型荟萃分析汇总数据。进行了不同的分析以确保结果的准确性。
28 项研究纳入高钠血症发生率的荟萃分析。与安慰剂相比，vaptans 治疗导致高钠血症的风险更高（3.8%比 1.0%，优势比[OR]2.69；95%置信区间[CI]1.97-3.68）。基线低钠血症亚组的高钠血症发生率风险较低；然而，使用袢利尿剂会增加风险。14 项研究纳入血清钠校正过度发生率的分析。与安慰剂相比，使用 vaptans 导致血清钠校正过度的风险更高（4.4%比 1.4%；OR 2.26；95% CI 1.32-3.86）。
与安慰剂相比，vaptans 在高钠血症和血清钠校正过度的发生率方面显示出更高的风险。此外，与袢利尿剂联合使用会增加高钠血症的风险。低钠血症和正常血清钠的患者均应关注血清钠校正过度的风险。使用低剂量的 vaptans 可以降低这两种风险。
