Kidney Week

Abstract: SA-OR91

Impact of Targeted Hyponatremia Correction on 30-Day Mortality and Rehospitalization Rate

Session Information

• High-Impact Clinical Trials - 2
  October 26, 2024 | Location: Hall D, Convention Center
  Abstract Time: 10:35 AM - 10:50 AM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Refardt, Julie, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Julie Refardt, MD, PhD

• Potasso, Laura, Universitatsspital Basel, Basel, BS, Switzerland

Laura Potasso, PhD, MD

• Pelouto, Anissa, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Anissa Pelouto, MD, MS, MSc

• Gregoriano, Claudia, University Hospital Aarau, Aarau, Switzerland

Claudia Gregoriano, PhD

• Koster, Markus, Kantonsspital St Gallen, Sankt Gallen, SG, Switzerland

Markus Koster, MD

• Vodanovic, Ivana Dora, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia

Ivana Dora Vodanovic, DrMed, MD

• Norello, Dario, Careggi University Hospital, Florence, Italy

Dario Norello, PhD, MD

• Ravioli, Svenja, Universitatsklinikum Koln, Cologne, Germany

Svenja Ravioli

• Cukoski, Sadrija, Universitatsklinikum Koln, Cologne, Germany

Sadrija Cukoski

• Sambula, Lana, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia

Lana Sambula, MD

• Rapsch, Nikola, Universitatsklinikum Koln, Cologne, Germany

Nikola Rapsch

• Monnerat, Sophie, Universitatsspital Basel, Basel, BS, Switzerland

Sophie Monnerat, MD, DrMed, PhD

• Beck, Julia, Universitatsspital Basel, Basel, BS, Switzerland

Julia Beck

• Vogt, Deborah R., Universitatsspital Basel, Basel, BS, Switzerland

Deborah R. Vogt, PhD

• Bontognali, Martina Luisa, Kantonsspital St Gallen, Sankt Gallen, SG, Switzerland

Martina Luisa Bontognali, MD

• Schuetz, Philipp, University Hospital Aarau, Aarau, Switzerland

Philipp Schuetz, MPH

• Zandbergen, Adrienne Anne Marie, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Adrienne Anne Marie Zandbergen, MD, PhD

• Peri, Alessandro, Careggi University Hospital, Florence, Italy

Alessandro Peri, MD, PhD

• Kastelan, Darko, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia

Darko Kastelan, PhD, MD

• Lindner, Gregor, Kantonsspital Solothurn, Solothurn, Switzerland

Gregor Lindner, MD, MBA

• Leuppi, Jörg Daniel, Kantonsspital Baselland, Liestal, Basel-Landschaft, Switzerland

Jörg Daniel Leuppi, PhD, MD

• Mueller, Beat, University Hospital Aarau, Aarau, Switzerland

Beat Mueller, MD

• Burst, Volker Rolf, Universitatsklinikum Koln, Cologne, Germany

Volker Rolf Burst, MD

• Hoorn, Ewout J., Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Ewout J. Hoorn, MD, PhD

• Christ-Crain, Mirjam, Universitatsspital Basel, Basel, BS, Switzerland

Mirjam Christ-Crain

Group or Team Name

• The HIT Study Group.

Background

Chronic hyponatremia is associated with increased mortality and rehospitalization rates, but it is unclear whether this relationship is causal. This leads to uncertainties in correction, which is therefore often slow or non-existent.
The aim of this study was therefore to evaluate the direct effects of targeted hyponatremia correction versus routine care on mortality and rehospitalization rates.

Methods

Randomized controlled, superiority, parallel-group, international multi-center trial with blinded outcome assessment. Hospitalized participants with hyponatremia <130 mmol/L from nine tertiary centers across Europe were assigned to undergo either targeted correction of plasma sodium levels according to guidelines (intervention) or routine care for hyponatremia (control). The primary outcome was the combined risk of death or rehospitalization within 30 days of study inclusion.

Results

2174 patients were included in the primary analysis of which 1079 (49.6%) were randomized to the intervention and 1095 (50.4%) to the control group. Through the intervention, 641 (60.4%) patients reached normonatremia, compared to 493 (46.2%) patients in the control group.
Within 30 days, death or rehospitalization occurred in 93 (8.6%) and 138 (13.0%) patients in the intervention group, compared to 93 (8.5%) and 151 (14.0%) patients in the control group, leading to a combined event rate of 21.0% (224/1079 patients) in the intervention group and 22.2% (239/1095 patients) in the control group, estimated absolute difference in proportions [95% CI] -1.2% [-4.7, 2.3], p=0.50. This result was robust in the per protocol analysis and in subgroup analyses considering hyponatremia etiology, severity or correction rate.

Conclusion

In this large hyponatremia intervention trial, targeted plasma sodium correction did not reduce 30-day mortality and rehospitalization rates. This suggests that in hospitalized patients, chronic hyponatremia is a marker of disease severity rather than a cause of worse outcome.

Funding

• Government Support - Non-U.S.