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Shi LT, Feng Z, Zhu CM. A retrospective study: exploring preoperative hyponatremia in elderly patients with hip fractures. J Orthop Surg Res 2024; 19:186. [PMID: 38491543 PMCID: PMC10943773 DOI: 10.1186/s13018-024-04643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population. METHODS This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types. RESULTS The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures. CONCLUSION Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.
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Affiliation(s)
- Li-Tao Shi
- Trauma Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, No. 36 of Nanyingzi Street, Shuangqiao District, Chengde, 067000, China.
| | - Zhen Feng
- Trauma Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, No. 36 of Nanyingzi Street, Shuangqiao District, Chengde, 067000, China
| | - Cui-Min Zhu
- Department of Ultrasound, Longhua County Guo Jia Tun Central Hospital, Chengde, 067000, China
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2
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Inoue M, Nakai K, Tanaka S, Mitsuiki K, Tokumoto M, Tsuruya K, Kitazono T, Nakano T. Prevalence of hyponatremia and associated factors in patients with chronic kidney disease: the Fukuoka Kidney Disease Registry (FKR) study. Clin Exp Nephrol 2023; 27:1023-1031. [PMID: 37642786 DOI: 10.1007/s10157-023-02395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hyponatremia is a common and important electrolyte disorder. However, the prevalence and factors associated with hyponatremia in patients with chronic kidney disease (CKD) are unknown. METHODS We studied the factors associated with hyponatremia (< 135 mEq/L) in CKD patients registered in the Fukuoka Kidney Disease Registry (FKR) study using a logistic regression model variable selected using the variable reduction method. RESULTS We analyzed the baseline characteristics of 4367 participants with CKD (age, 64 ± 16 years; male, 56.1%). Hyponatremia was detected in 2.0% of the patients at baseline, and multivariate logistic analysis showed that the independent factors for hyponatremia were body mass index (odds ratio [OR] 0.91; 95% confidence interval [CI] 0.85-0.97), prescription of benzodiazepine (OR 2.31; 95% CI 1.39-3.86), blood hemoglobin level (OR 0.76; 95% CI 0.65-0.88), and serum C-reactive protein level (OR 1.27; 95% CI 1.04-1.54). CONCLUSION The cross-sectional analysis using baseline data from the FKR study revealed independent factors associated with hyponatremia in patients with decreased kidney function. Longitudinal analyses of the FKR cohort are needed to evaluate the effects of these factors on the prognosis of hyponatremia in patients with CKD.
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Affiliation(s)
- Megumi Inoue
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kentaro Nakai
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduated School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Masanori Tokumoto
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduated School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduated School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan.
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3
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Aguilera Peiró P. [Therapeutic options for the management of acute hepatic porphyria]. Med Clin (Barc) 2023; 159 Suppl 1:S29-S32. [PMID: 37827883 DOI: 10.1016/j.medcli.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 10/14/2023]
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Tang H, Xu C, Zhang P, Luo T, Huang Y, Yang X. A profile of SGLT-2 inhibitors in hyponatremia: The evidence to date. Eur J Pharm Sci 2023; 184:106415. [PMID: 36870579 DOI: 10.1016/j.ejps.2023.106415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Hyponatremia is the most common electrolyte disorder in clinical practice, which may lead to life-threatening complications. Several lines of evidence suggest that hyponatremia is associated not only with significant increases in length of stay, cost, and financial burden, but also with increased morbidity and mortality. Hyponatremia is also considered to be a negative prognostic factor in patients with heart failure and cancer. Although multiple therapeutic methods are available for treating hyponatremia, most have some limitations, such as poor compliance, rapid correction of serum Na+, other negative side effects and high cost. Given these limitations, identifying novel therapies for hyponatremia is essential. Recent clinical studies have shown that SGLT-2 inhibitors (SGLT 2i) significantly increased serum Na+ levels and were well tolerated by patients who underwent this treatment. Therefore, oral administration of SGLT 2i appears to be an effective treatment for hyponatremia. This article will briefly review the etiology of hyponatremia and integrated control of sodium within the kidney, current therapies for hyponatremia, potential mechanisms and efficacy of SGLT 2i for hyponatremia, and the benefits in cardiovascular, cancer, and kidney disease by regulating sodium and water balance.
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Affiliation(s)
- Hui Tang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China
| | - Changjing Xu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Piao Zhang
- Department of Pharmacy, Ya 'an People's Hospital, Ya 'an, Sichuan 646000, China
| | - Taimin Luo
- Department of pharmacy, Chengdu Seventh People's Hospital, Chengdu, Sichuan 610000, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; School of Pharmacy, Southwest Medical University, Luzhou 646000, China.
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5
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Joseph A, Sayeed T, Patel DK, Aiyadurai S, Shahbaz Z, Mettela SR, Garg T, Gadde R, Udoeyop D, Khan A. Central Pontine Myelinolysis With Carbamazepine-Induced Syndrome of Inappropriate Antidiuretic Hormone and Its Management: A Case Report and Literature Review. Cureus 2023; 15:e35816. [PMID: 37033593 PMCID: PMC10075004 DOI: 10.7759/cureus.35816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Aggressive treatment of hyper or hypoosmolar conditions can trigger osmotic demyelination syndrome. We describe the case of a 53-year-old male who began using carbamazepine to treat bipolar affective disorder and was later diagnosed with carbamazepine-induced syndrome of inappropriate antidiuretic hormone secretion. The patient's mental state gradually improved once the hyponatremia was corrected using 3% normal saline and supportive therapy. The patient presented to the outpatient clinic with confusion and altered sensorium. Brain computed tomography showed diffuse cerebral atrophy and periventricular ischemia demyelination alterations, and magnetic resonance imaging showed an enhanced section in the brainstem that included the pons, suggesting osmotic demyelination alterations. Ventilatory support and supportive therapy were initiated, and hyponatremia was rectified. Although the patient did well with the treatment, his prognosis was still dismal, so he was sent home with instructions to follow up.
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Reed LK, Nguyen AV, Soto JM, Robinson TM, Huang JH, Vance AZ. Safety of Contemporary Carotid Artery Stenting and Associated Risk Factors for Treatment of Carotid Artery Stenosis. World Neurosurg 2022; 165:e223-e234. [PMID: 35691520 DOI: 10.1016/j.wneu.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of carotid artery atherosclerosis and stroke is increasing. Carotid artery stenting (CAS), which treats carotid artery stenosis and prevents strokes, has benefited from advances in techniques and technology. In this study, we aimed to identify significant risk factors for major complications following contemporary CAS. METHODS Utilizing the National Surgical Quality Improvement Program registry, we investigated individuals who underwent CAS between the years 2015-2018. Multivariable logistic regression was performed to identify risk factors associated with stroke, myocardial infarction (MI), and death within 30 days of CAS. RESULTS Of the 770 patients within the National Surgical Quality Improvement Program registry who met study criteria, 3.2% experienced strokes, 1.6% experienced MIs, and 2.2% died within 30 days of CAS. A total of 6.1% of patients experienced any of these major complications. Of the 395 asymptomatic patients, 3.5% suffered a stroke, 1.5% experienced an MI, and 1.0% died for a total of 5.6% patients suffering from any event. Of the 375 symptomatic patients, there were 2.9% strokes, 1.6% MIs, and 3.5% deaths with 6.7% suffering any event. Age, race, and hyponatremia were significantly associated with stroke, and hyponatremia was associated with MI. Age, anemia, hypoalbuminemia, international normalized ratio, and emergency case were associated with death. CONCLUSIONS These results suggest that preoperative risk stratification of CAS patients may not be straightforward as each adverse event has its own risk factors, precluding a generalized CAS risk stratification scoring system from being created. This paper can aid in patient selection for CAS by highlighting risk factors in modern CAS.
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Affiliation(s)
- Laura K Reed
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA.
| | - Anthony V Nguyen
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jose M Soto
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA
| | - T Matthew Robinson
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA; Methodist Neurological Institute, Houston Methodist Willowbrook Hospital, Houston, Texas, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Awais Z Vance
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA
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Sato A, Yasui‐Furukori N, Oda Y, Yang M, Suzuki Y, Shinozaki M, Shimizu T, Shimoda K. Asymptomatic syndrome of inappropriate secretion of antidiuretic hormone (
SIADH
) following duloxetine treatment for pain with depression: Two case reports. Neuropsychopharmacol Rep 2022; 42:387-390. [PMID: 35733329 PMCID: PMC9515710 DOI: 10.1002/npr2.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Aoi Sato
- Department of Psychiatry Dokkyo Medical University, School of Medicine Shimotsuga‐gun Japan
| | - Norio Yasui‐Furukori
- Department of Psychiatry Dokkyo Medical University, School of Medicine Shimotsuga‐gun Japan
| | - Yumiko Oda
- Department of Psychiatry Dokkyo Medical University, School of Medicine Shimotsuga‐gun Japan
| | - Misa Yang
- Department of Diagnostic and Generalist Medicine Dokkyo Medical University Hospital, School of Medicine Shimotsuga‐gun Japan
| | - Yudai Suzuki
- Department of Diagnostic and Generalist Medicine Dokkyo Medical University Hospital, School of Medicine Shimotsuga‐gun Japan
| | - Masataka Shinozaki
- Department of Psychiatry Dokkyo Medical University, School of Medicine Shimotsuga‐gun Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine Dokkyo Medical University Hospital, School of Medicine Shimotsuga‐gun Japan
| | - Kazutaka Shimoda
- Department of Psychiatry Dokkyo Medical University, School of Medicine Shimotsuga‐gun Japan
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8
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Clinical efficacy of urea treatment in syndrome of inappropriate antidiuretic hormone secretion. Sci Rep 2022; 12:10266. [PMID: 35715573 PMCID: PMC9206077 DOI: 10.1038/s41598-022-14387-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this work is to examine our experience in the use of urea in patients with SIADH. Observational retrospective analysis of 48 patients with SIADH that have been treated with urea in a third-level hospital. Pre-post analysis of serum sodium levels. The 48 patients with SIADH had a median age of 78.5 (range 26–97 years). The serum sodium nadir was 119.8 ± 5.0 mmoL/L and at the beginning of treatment 125.6 ± 4.1 mmoL/L. The patients continued the treatment for a mean time of 2.95 ± 6.29 months, being the treatment still active in 4 patients. In all patients there was an improvement in serum sodium, being the final serum sodium at the end of treatment 134.4 ± 4.9 mmoL/L (p < 0.01). This improvement was observed from the first week. Adverse events were only detected in 2 patients with mild digestive symptomatology and 2 patients refused the treatment due to the low palatability of the urea. There was an economic cost reduction of 87.9% in comparison with treatment with tolvaptan. Urea has shown to be a safe and cost-effective option for the treatment of hyponatremia caused by SIADH.
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9
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Oxcarbazepine and Hyponatremia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050559. [PMID: 35629976 PMCID: PMC9147388 DOI: 10.3390/medicina58050559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Hyponatremia is one of the most common adverse effects in patients treated with oxcarbazepine (OXC). Different risk factors for OXC-induced hyponatremia have been described as age, female gender, dosage, and combination with other drugs During our clinical practice, we noticed that a longer duration of treatment with OXC could be associated with a higher risk of hyponatremia, therefore, in this study, we aimed to evaluate factors that may increase the risk of OXC-induced hyponatremia. Materials and Methods: Data were retrospectively collected from our clinical database at the Department of Neurology of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. The sample was divided into three groups: OXC consumers (n = 31), other anti-seizure medications (ASMs) consumers (n = 43), and controls absent ASMs (n = 31). All groups were matched by age and gender. Hyponatremia was defined as <136 mmol/L. Results: The frequency of hyponatremia was significantly higher among OXC patients (61.3%) compared to other ASM patients (5.4%) and controls (3.2%). The mean serum sodium concentration in the OXC group was 133.1 ± 5.1 mmol/L. The frequency of severe hyponatremia among OXC-treated patients was 19.4%; this subgroup was older than patients with moderate hyponatremia and normonatremia and had a longer OXC treatment duration compared to a subgroup of normonatremia. The average duration of OXC therapy was 8.7 ± 5.5 years with a range from 1 to 21 years. Serum sodium concentration and duration of treatment with OXC demonstrated a significant negative correlation (r = −0,427, p = 0.017). Each year of therapy with OXC increased the risk of hyponatremia 1.3 times (OR = 1.326, 95% Cl 1.027−1.712, p = 0.031). Other factors (gender, age, polypharmacy, OXC dosage, and serum concentration) did not show a significant association with the development of hyponatremia. Conclusions: Longer duration of treatment with OXC is an important factor in the development and severity of hyponatremia.
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Girault-Sotias PE, De Mota N, Llorens-Cortès C. [Physiological role of the apelin receptor: implication in body fluid homeostasis and hyponatremia]. Biol Aujourdhui 2022; 215:119-132. [PMID: 35275056 DOI: 10.1051/jbio/2021012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 06/14/2023]
Abstract
Apelin, a vasoactive neuropeptide, its receptor and arginine-vasopressin (AVP, antidiuretic hormone) are co-localized in magnocellular vasopressinergic neurons. In the kidney, the apelin receptor is present in glomerular arterioles and the collecting duct (CD) where the AVP type 2 (V2-R) receptors are located. Apelin exerts an aquaretic action both by its inhibitory effect on the phasic electrical activity of vasopressinergic neurons and the secretion of AVP into the bloodstream and by its direct actions at the kidney level resulting in an increase in the renal microcirculation and the inhibition of the antidiuretic effect of AVP mediated by V2-R in the CD. Plasma apelin and AVP are conversely regulated by osmotic stimuli in both humans and rodents, showing that apelin is involved with AVP in maintaining body fluid homeostasis. Clinically, in patients with inappropriate antidiuresis syndrome (SIAD), the apelin/AVP balance is altered, which contributes to water metabolism defect. Activation of the apelin receptor by the metabolically stable apelin-17 analog, that increases aqueous diuresis and moderately water intake and gradually corrects hyponatremia, may constitute a new approach for the treatment of SIAD.
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Affiliation(s)
- Pierre-Emmanuel Girault-Sotias
- Laboratoire « Neuropeptides centraux et régulations hydrique et cardiovasculaire », Centre Interdisciplinaire de Recherche en Biologie, INSERM U1050, Collège de France, Paris, France
| | - Nadia De Mota
- Laboratoire « Neuropeptides centraux et régulations hydrique et cardiovasculaire », Centre Interdisciplinaire de Recherche en Biologie, INSERM U1050, Collège de France, Paris, France
| | - Catherine Llorens-Cortès
- Laboratoire « Neuropeptides centraux et régulations hydrique et cardiovasculaire », Centre Interdisciplinaire de Recherche en Biologie, INSERM U1050, Collège de France, Paris, France
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Bartalis E, Gergics M, Tinusz B, Földi M, Kiss S, Németh D, Solymár M, Szakács Z, Hegyi P, Mezösi E, Bajnok L. Prevalence and Prognostic Significance of Hyponatremia in Patients With Lung Cancer: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:671951. [PMID: 34950676 PMCID: PMC8688712 DOI: 10.3389/fmed.2021.671951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/29/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The prevalence of hyponatremia is highly variable among patients with lung cancer. However, its prevalence and prognostic significance in subgroups of patients with lung cancer have not yet been evaluated in a meta-analysis. Methods: We have registered our meta-analysis and review protocol to the PROSPERO International Prospective Register of Systematic Reviews, with the following registration number: CRD42020167013. A systematic search was done in the following sources: MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, a WHO Global Health Library. Results: We identified a total of 8,962 potentially eligible studies, and we included 31 articles in our evaluation. The prevalence of hyponatremia in patients with lung cancer varied between 3 and 94.8% with an average of 25% without any significant differences between the following subgroups: histotype, gender, age, Eastern Cooperative Oncology Group (ECOG) state, and the extent of disease. The overall survival (OS) was significantly lower in hyponatremic compared to normonatremic patients at 10 months [RR.59 (95% CI.47-0.74), p < 0.001] and at 20 months [RR.44 (95% CI.33-0.59), p < 0.001], with worse survival rates in non-small cell lung cancer (NSCLC) [RR.27 (95% CI.12-0.44), p < 0.001] than in small cell lung cancer (SCLC) [RR.42 (95% CI.27-0.57), p < 0.001]. If hyponatremia was corrected, OS at 10 months was significantly higher than in the uncorrected hyponatremia group [RR 1.83 (95% CI 1.37-2.44), p < 0.001], but, at 20 months, no statistically significant difference could be found between these subgroups [RR 2.65 (95% CI.94-7.50), p = 0.067]. Conclusions: Patients with lung cancer diagnosed with hyponatremia, especially patients with NSCLC, seem to have significantly lower survival rates than normonatremic patients. If hyponatremia remains uncorrected, the mortality rates might be even higher.
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Affiliation(s)
- Eszter Bartalis
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Marin Gergics
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Benedek Tinusz
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Mária Földi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Szabolcs Kiss
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Dávid Németh
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Margit Solymár
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Emese Mezösi
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Bajnok
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
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12
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Potential Use of Pharmacogenetics to Reduce Drug-Induced Syndrome of Inappropriate Antidiuretic Hormone (SIADH). J Pers Med 2021; 11:jpm11090853. [PMID: 34575630 PMCID: PMC8466173 DOI: 10.3390/jpm11090853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
Syndrome of inappropriate antidiuretic hormone (SIADH) is a common cause of hyponatremia, and many cases represent adverse reactions to drugs that alter ion channel conductance within the peptidergic nerve terminals of the posterior pituitary. The frequency of drug-induced SIADH increases with age; as many as 20% of patients residing in nursing homes have serum sodium levels below 135 mEq/L. Mild hyponatremia is associated with cognitive changes, gait instability, and falls. Severe hyponatremia is associated with cerebral edema, seizures, permanent disability, and/or death. Although pharmacogenetic tests are now being deployed for some drugs capable of causing SIADH (e.g., antidepressants, antipsychotics, and opioid analgesics), the implementation of these tests has been based upon the prior known association of these drugs with other serious adverse drug reactions (e.g., electrocardiographic abnormalities). Work is needed in large observational cohorts to quantify the strength of association between pharmacogene variants and drug-induced SIADH so that decision support can be developed to identify patients at high risk.
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13
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Girault-Sotias PE, Gerbier R, Flahault A, de Mota N, Llorens-Cortes C. Apelin and Vasopressin: The Yin and Yang of Water Balance. Front Endocrinol (Lausanne) 2021; 12:735515. [PMID: 34880830 PMCID: PMC8645901 DOI: 10.3389/fendo.2021.735515] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022] Open
Abstract
Apelin, a (neuro)vasoactive peptide, plays a prominent role in controlling body fluid homeostasis and cardiovascular functions. Experimental data performed in rodents have shown that apelin has an aquaretic effect via its central and renal actions. In the brain, apelin inhibits the phasic electrical activity of vasopressinergic neurons and the release of vasopressin from the posterior pituitary into the bloodstream and in the kidney, apelin regulates renal microcirculation and counteracts in the collecting duct, the antidiuretic effect of vasopressin occurring via the vasopressin receptor type 2. In humans and rodents, if plasma osmolality is increased by hypertonic saline infusion/water deprivation or decreased by water loading, plasma vasopressin and apelin are conversely regulated to maintain body fluid homeostasis. In patients with the syndrome of inappropriate antidiuresis, in which vasopressin hypersecretion leads to hyponatremia, the balance between apelin and vasopressin is significantly altered. In order to re-establish the correct balance, a metabolically stable apelin-17 analog, LIT01-196, was developed, to overcome the problem of the very short half-life (in the minute range) of apelin in vivo. In a rat experimental model of vasopressin-induced hyponatremia, subcutaneously (s.c.) administered LIT01-196 blocks the antidiuretic effect of vasopressin and the vasopressin-induced increase in urinary osmolality, and induces a progressive improvement in hyponatremia, suggesting that apelin receptor activation constitutes an original approach for hyponatremia treatment.
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Zeng QL, He WT, Yuan G. Higher plasma NT-proBNP levels correlate with syndrome of inappropriate antidiuretic hormone and poor prognosis in neurological patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:28. [PMID: 33553321 PMCID: PMC7859746 DOI: 10.21037/atm-20-3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Hyponatremia induced by syndrome of inappropriate antidiuretic hormone secretion (SIADH) was common electrolyte disturbance encountered in critically ill neurological diseases, which has normal or increased fluid volume. Brain natriuretic peptide (BNP), which is released in equal proportion to N-terminal pro-brain natriuretic peptide (NT-proBNP), plays vital roles in regulation of volume status. The relationship between SIADH and NT-proBNP levels in neurological diseases has rarely been reported. Methods A retrospective cross-sectional study was conducted to analyze plasma NT-proBNP levels in 33 patients with SIADH and 23 controlled eunatremic patients with neurological diseases. Results Baseline NT-proBNP levels were compared between two groups [SIADH group: median 311 pg/mL, interquartile range (IQR) 110–768 pg/mL] vs. eunatremic group: median 46 pg/mL, IQR, 12–96 pg/mL) (P<0.05). Plasma NT-proBNP levels were markedly increased in hyponatremic patients who had two or more complications than those who had less complication (P<0.05). In SIADH patients, NT-proBNP levels in remission phase were lower to levels at baseline. Furthermore, no death was seen in eunatremic patients, while five SIADH patients died from complications. Conclusions SIADH had higher plasma NT-proBNP levels and poorer prognosis compared to eunatremic neurological patients. NT-proBNP serves as a biomarker of disease severity while not extracellular volume (ECV) status in critically ill neurological patients.
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Affiliation(s)
- Qing-Ling Zeng
- Merck Serono (China) Co. Ltd., Chengdu, China.,Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Tao He
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wu R, Li C, Wang Z, Fan H, Song Y, Liu H. A narrative review of progress in diagnosis and treatment of small cell lung cancer patients with hyponatremia. Transl Lung Cancer Res 2020; 9:2469-2478. [PMID: 33489807 PMCID: PMC7815354 DOI: 10.21037/tlcr-20-1147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small cell lung cancer (SCLC) is one of the malignant cancers of lung tumors, and hyponatremia, defined as serum sodium concentration (Na+) lower than 135 mmol/L, is the most common complication of solid tumors, with an incidence of up to 18.9% and a negative impact on quality of life in SCLC. As a prognostic index of SCLC, timely monitoring and correcting of hyponatremia is of great clinical significance for prolonging the survival period of patients. In the explore of new drugs for small cell lung cancer, it is necessary to include hyponatremia as an evaluation index in clinical studies. As the occurrence of hyponatremia is sometimes unavoidable owing to SCLC specific neurological characteristics, early monitoring to detect the presence of hyponatremia and timely correction are helpful to improve the prognosis of patients. There are many predisposing factors for hyponatremia, including heterotopia of antidiuretic hormone (ADH), use of platinum-based chemotherapy drugs, and intracranial metastasis, among others. Patients with small cell lung cancer are usually asymptomatic in the early stage, while it is of great significance to find a suitable clinical index to judge whether it is a malignant inducement or not. In the clinical setting, due to different electrolyte levels and therapeutic scheduling for the primary disease, an individualized plan is often made, mainly comprising water restriction, infusion, and medications. This review includes related clinical studies and describes the common symptoms and predisposing factors of hyponatremia in patients with SCLC, and their impact on quality of life and prognosis.
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Affiliation(s)
- Ranpu Wu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China
| | - Chuling Li
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Zimu Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Hang Fan
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
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Zhao L, Wang X, Zhang X, Liu X, Ma N, Zhang Y, Zhang S. Therapeutic strategies for acute intermittent porphyria. Intractable Rare Dis Res 2020; 9:205-216. [PMID: 33139979 PMCID: PMC7586882 DOI: 10.5582/irdr.2020.03089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Acute intermittent porphyria (AIP) is an autosomal dominant disease caused by mutations in porphobilinogen deaminase (PBGD), the third enzyme of the heme synthesis pathway. Symptoms of AIP usually manifest as intermittent acute attacks with occasional neuropsychiatric crises. The management of AIP includes treatment of acute attacks, prevention of attacks, long-term monitoring and treatment of chronic complications. Intravenous injection of heme is the most effective method of treating acute attacks. Carbohydrate loading is used when heme is unavailable or in the event of mild attacks. Symptomatic treatment is also needed during attacks. Prevention of attacks includes eliminating precipitating factors, heme prophylaxis and liver transplantation. New treatment options include givosiran (siRNA) to down-regulate ALA synthase-1 (ALAS1) and the messenger RNA of PBGD (PBGD mRNA) delivered to the liver cells of patients with AIP. Long-term monitoring of chronic complications includes regular liver-kidney function and hepatocellular carcinoma (HCC) screening.
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Affiliation(s)
- Lanlan Zhao
- Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xinyang Wang
- Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoning Zhang
- Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiantao Liu
- Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ningzhen Ma
- Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yiran Zhang
- School of First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, China
| | - Songyun Zhang
- Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Address correspondence to:Songyun Zhang, Department of Endocrinology, The second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China. E-mail:
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Ramírez E, Rodríguez A, Queiruga J, García I, Díaz L, Martínez L, Muñoz R, Muñoz M, Tong HY, Martínez JC, Borobia AM, Carcas AJ, Frías J. Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program. Clin Pharmacol Ther 2019; 106:1362-1379. [DOI: 10.1002/cpt.1562] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/08/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Amelia Rodríguez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Javier Queiruga
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Irene García
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Lucía Díaz
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Lucía Martínez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Raúl Muñoz
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Mario Muñoz
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Hoi Y. Tong
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - José Carlos Martínez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Alberto M. Borobia
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Antonio J. Carcas
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Jesús Frías
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
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