Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia: A Systematic Review and...

Area of Science:

• Nephrology
• Internal Medicine
• Critical Care Medicine

Background:

• Current guidelines for severe hyponatremia treatment emphasize slow sodium correction to prevent osmotic demyelination syndrome (ODS).
• Emerging evidence indicates a potential association between slower correction rates and increased patient mortality.

Purpose of the Study:

• To investigate the relationship between the rate of serum sodium correction and mortality in hospitalized adult patients diagnosed with severe hyponatremia.

Main Methods:

• A systematic review and meta-analysis of comparative studies published between January 2013 and October 2023.
• Searched multiple databases including MEDLINE, Embase, and Web of Science for relevant literature.
• Included 16 cohort studies with 11,811 patients, assessing rapid (≥8-10 mEq/L/24h) versus slow (<8 mEq/L/24h) or very slow (<4-6 mEq/L/24h) correction rates.

Main Results:

• Moderate-certainty evidence indicated rapid correction was associated with significantly fewer in-hospital deaths compared to slow and very slow correction.
• Low-certainty evidence showed rapid correction correlated with reduced 30-day mortality and shorter hospital length of stay (LOS).
• No statistically significant increase in the risk of osmotic demyelination syndrome (ODS) was observed with rapid correction.

Conclusions:

• Slow and very slow correction of severe hyponatremia are associated with increased risks of mortality and prolonged hospital LOS.
• Rapid correction of severe hyponatremia appears to be a safer and more effective treatment strategy regarding mortality and LOS.
• Findings challenge existing treatment paradigms and suggest a re-evaluation of hyponatremia management protocols is warranted.