Original InvestigationEfficacy of Furosemide, Oral Sodium Chloride, and Fluid Restriction for Treatment of Syndrome of Inappropriate Antidiuresis (SIAD): An Open-label Randomized Controlled Study (The EFFUSE-FLUID Trial)
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Section snippets
Study Population
Eligible patients were hospitalized patients who were 18 years or older with a serum [Na+] ≤ 130 mmol/L due to SIAD. For a firm diagnosis of SIAD, all the following criteria had to have been met: (1) serum osmolality < 275 mOsm/kg, (2) urine osmolality > 100 mOsm/kg, (3) clinical euvolemia diagnosed from the history and physical examination, (4) urine [Na+] > 30 mmol/L, and (5) absence of hypothyroidism, glucocorticoid deficiency, estimated glomerular filtration rate < 60 mL/min/1.73 m2 or diagnosed acute
Study Population
A total of 289 patients were screened. Of those, 92 patients underwent randomization (31 in the FR group, 30 in the FR+FM group, and 31 in the FR+FM+NaCl group; Fig 1). Two patients withdrew consent after randomization; however, both were included in outcome analyses. Overall, 66 (72%) patients completed a final visit and 10 (11%) patients died during the follow-up period; 87 (95%) of the participants had data relating to the primary objective. The percentage of patients receiving the trial
Discussion
We conducted this study because to our knowledge there has never been an RCT comparing the efficacy of fluid restriction versus furosemide and/or use of an NaCl supplement in the treatment of patients with SIAD. Our findings have shown that among patients with hyponatremia due to SIAD, there was no evidence that treatments with once-daily furosemide and/or a 3-g NaCl supplement add-on to fluid restriction resulted in a greater change in [Na+] in comparison to fluid restriction alone on day 4
Article Information
Authors’ Full Names and Academic Degrees
Pajaree Krisanapan, MD, Surachet Vongsanim, MD, Pathomporn Pin-on, MD, Chidchanok Ruengorn, PhD, and Kajohnsak Noppakun, MD.
Authors’ Contributions
Research idea and study design: KN, PK; data acquisition: PK; data analysis/interpretation: KN, PK, PP, CR, SV; statistical analysis: KN, CR; supervision or mentorship: KN, CR. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual’s own contributions and to ensure that
References (34)
Age and gender as risk factors for hyponatremia and hypernatremia
Clin Chim Acta
(2003)- et al.
Incidence and prevalence of hyponatremia
Am J Med
(2006) - et al.
Electrolyte disorders in community subjects: prevalence and risk factors
Am J Med
(2013) - et al.
Hyponatremia and mortality: moving beyond associations
Am J Kidney Dis
(2013) - et al.
Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations
Am J Med
(2013) - et al.
Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study
Am J Med
(2010) - et al.
The urine/plasma electrolyte ratio: a predictive guide to water restriction
Am J Med Sci
(2000) Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis
Am J Med
(2006)- et al.
Effect of furosemide on free water excretion in edematous patients with hyponatremia
Kidney Int
(1973) - et al.
Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects
Am Heart J
(2003)
Clinical practice guideline on diagnosis and treatment of hyponatraemia
Nephrol Dial Transplant
Mild hyponatremia as a risk factor for fractures: the Rotterdam Study
J Bone Miner Res
Hyponatremia independent of osteoporosis is associated with fracture occurrence
Clin J Am Soc Nephrol
Hyponatremia-induced osteoporosis
J Bone Miner Res
Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits
Am J Med
Treatment of hyponatremia induced by the syndrome of inappropriate antidiuretic hormone secretion: a multidisciplinary Spanish algorithm
Nefrologia
Evaluation of hyponatremia: a little physiology goes a long way
Cleve Clin J Med
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