Evaluation of desmopressin in preventing overcorrection of hyponatraemia among patients with renal dysfunction

Hyponatraemia is a common cause of hospital admissions, and correcting sodium levels should be done gradually to avoid complications, including osmotic demyelination syndrome. Desmopressin can be used to prevent rapid fluctuations in sodium. While effective, limited evidence exists regarding its use in patients with renal dysfunction, and package inserts recommend avoiding use in patients with a creatinine clearance (CrCl) of <50 mL/min. The aim of this study was to determine the safety and efficacy of desmopressin in patients with renal dysfunction compared with those with no renal dysfunction.

This retrospective cohort study was conducted at a single academic medical centre. Adult patients with an initial sodium concentration of <125 mmol/L who received desmopressin were included. The primary outcome was the rate of sodium overcorrection (>8 mmol/L) 24 hours after desmopressin in patients with renal dysfunction (CrCl <50 mL/min) versus those with no renal dysfunction. Secondary outcomes included proportion of patients achieving a 5-10 mEq/L increase within 24 hours and overcorrection rates at 24 and 48 hours. Data were analysed using the test χ², t test and Mann-Whitney U test.

72 patients were included in the study and 20 had renal dysfunction. The most common desmopressin dosing strategy in both groups was rescue. Baseline sodium was comparable between the groups: 113.8±7.5 versus 115.6±3.73 mmol/L. However, sodium before desmopressin administration was more elevated in the renal dysfunction group (124.1±9.8 vs 129.3±7.8 mmol/L; p=0.04) who also received more sodium through intravenous fluids (284.2 vs 90.7 mEq; p=0.001). There was no significant difference in overcorrection by >8 mmol/L, 24 hours post-desmopressin (9.6% vs 20%; p=0.43), but patients with renal dysfunction had higher rates of overcorrection at 24 hours post-admission (11.5% vs 35%; p=0.048).

This study did not show a significant difference in sodium overcorrection after desmopressin in patients with renal dysfunction. Further studies assessing the safety and efficacy of desmopressin in renal dysfunction are needed.