Abstract: TH-PO326
Exploring the Effectiveness of Urea in Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Comprehensive Systematic Review and Meta-Analysis
Session Information
- Sodium, Potassium, and Volume Disorders: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Lohana, Abhi, Camden Clark Medical Center, Parkersburg, West Virginia, United States
- Shivani, Fnu, Ascension Saint Joseph - Chicago, Chicago, Illinois, United States
- Neel, Sejal, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, United States
- Chander, Subhash, Mount Sinai Beth Israel Hospital, New York, New York, United States
- Shah, Syed Adil Mir, Dow Medical College, Karachi, Pakistan
- Muddana, Neeharika, Camden Clark Medical Center, Parkersburg, West Virginia, United States
Background
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) often leads to hyponatremia, posing significant health risks. Management strategies include urea administration, targeting osmotic diuresis, and Vaptan Receptor Antagonists (VRAs). This study systematically reviews the effectiveness of urea compared to VRAs and other interventions in increasing plasma sodium concentration among SIADH patients.
Methods
A comprehensive search yielded 16 relevant studies on urea treatment for SIADH-related hyponatremia. Meta-analysis assessed serum sodium level changes, considering treatment duration and SIADH severity. Safety profile analysis included adverse events.
Results
Urea significantly increased serum sodium levels (MD = 9.08, 95%CI: 7.64, 10.52, P < 0.01), with enduring efficacy over varying time frames. Subgroup analyses revealed comparable outcomes across different treatment durations and a severity-dependent effect favouring urea in severe SIADH cases. Serum urea levels significantly rose post-treatment (MD = 31.66, 95%CI: 16.05, 47.26, P < 0.01). Urea outperformed fluid restriction in increasing serum sodium (MD = 7.99, 95%CI: 6.25, 9.72, P < 0.01), with similar efficacy to VRAs. Meta-regression indicated urea's efficacy correlated inversely with SIADH severity. Urea was generally tolerable, with distaste as the primary adverse event.
Conclusion
Urea demonstrates consistent efficacy in raising serum sodium levels in SIADH-related hyponatremia, with a safety profile comparable to other treatments. Its enduring impact, even in severe cases, underscores its clinical significance as a management option. However, further randomized controlled trials are warranted to validate these findings and elucidate optimal treatment protocols.
Figure 1. Forest plot shows serum sodium level change from the baseline after urea administration.