Pelouto Anissa, Monnerat Sophie, Refardt Julie, Zandbergen Adrienne A M, Christ-Crain Mirjam, Hoorn Ewout J
Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
Nephrol Dial Transplant. 2025 Feb 4;40(2):283-293. doi: 10.1093/ndt/gfae164.
Oral urea is being used more commonly to treat hyponatremia, but factors contributing to the correction rate are unknown. We hypothesized that clinically relevant factors can be identified to help guide hyponatremia correction with oral urea.
This was a retrospective study in two university hospitals including hospitalized patients with hyponatremia (plasma sodium <135 mmol/L) treated with oral urea. Linear mixed-effects models were used to identify factors associated with hyponatremia correction. Rates of overcorrection, osmotic demyelination and treatment discontinuation were also assessed.
We included 161 urea treatment episodes in 140 patients (median age 69 years, 46% females, 93% syndrome of inappropriate antidiuresis). Oral urea succeeded fluid restriction in 117 treatment episodes (73%), was combined with fluid restriction in 104 treatment episodes (65%) and was given as the only treatment in 27 treatment episodes (17%). A median dose of 30 g/day of urea for 4 days (interquartile range 2-7 days) increased plasma sodium from 127 to 134 mmol/L and normalized hyponatremia in 47% of treatment episodes. Older age (β 0.09, 95% CI 0.02-0.16), lower baseline plasma sodium (β -0.65, 95% CI -0.78 to -0.62) and higher cumulative urea dose (β 0.03, 95% CI -0.02 to -0.03) were independently associated with a greater rise in plasma sodium. Concurrent fluid restriction was associated with a greater rise in plasma sodium only during the first 48 h of treatment (β 1.81, 95% CI 0.40-3.08). Overcorrection occurred in 5 cases (3%), no cases of osmotic demyelination were identified and oral urea was discontinued in 11 cases (11%) due to side effects.
During treatment with oral urea, older age, higher cumulative dose, lower baseline plasma sodium and initial fluid restriction are associated with a greater correction rate of hyponatremia. These factors may guide clinicians to achieve a gradual correction of hyponatremia with oral urea.
口服尿素正越来越普遍地用于治疗低钠血症，但影响纠正率的因素尚不清楚。我们假设可以识别出临床相关因素，以帮助指导口服尿素纠正低钠血症。
这是一项在两家大学医院进行的回顾性研究，纳入了接受口服尿素治疗的低钠血症住院患者（血浆钠<135 mmol/L）。采用线性混合效应模型来识别与低钠血症纠正相关的因素。还评估了纠正过度、渗透性脱髓鞘和治疗中断的发生率。
我们纳入了140例患者的161次尿素治疗疗程（中位年龄69岁，46%为女性，93%为抗利尿激素分泌异常综合征）。口服尿素在117个治疗疗程（73%）中成功替代了限液治疗，在104个治疗疗程（65%）中与限液治疗联合使用，在27个治疗疗程（17%）中作为唯一治疗方法使用。尿素中位剂量为30 g/天，持续4天（四分位间距2 - 7天），使血浆钠从127 mmol/L升至134 mmol/L，并在47%的治疗疗程中使低钠血症恢复正常。年龄较大（β 0.09，95%置信区间0.02 - 0.16）、基线血浆钠较低（β -0.65，95%置信区间-0.78至-0.62）和累积尿素剂量较高（β 0.03，95%置信区间0.02至0.03）与血浆钠升高幅度较大独立相关。同时进行限液治疗仅在治疗的前48小时与血浆钠升高幅度较大相关（β 1.81，95%置信区间0.40 - 3.08）。5例（3%）发生纠正过度，未发现渗透性脱髓鞘病例，11例（11%）因副作用停用口服尿素。
在口服尿素治疗期间，年龄较大、累积剂量较高、基线血浆钠较低和初始限液治疗与低钠血症较高的纠正率相关。这些因素可能指导临床医生通过口服尿素逐步纠正低钠血症。
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