Targeted Hyponatremia Correction Did Not Lower 30-Day Events

Key Takeaways

• The 30-day combined risk of death or rehospitalization was similar between targeted correction and routine care.
• Normonatremia was observed more often with targeted correction, affecting 60.4% of patients versus 46.2% with routine care.
• Overcorrection was uncommon in both groups, and no osmotic demyelination syndrome was observed.

Among hospitalized patients with chronic hyponatremia, targeted correction did not lower the 30-day combined risk of death or rehospitalization versus routine care, with an estimated absolute difference of -1.3 percentage points. The 95% confidence interval ranged from -4.9 to 2.2. Sodium normalization during treatment was more common with targeted correction, while the 30-day clinical outcome was similar between groups.

The multicenter randomized trial was a randomized, controlled, parallel-group study across nine European centers. Investigators enrolled hospitalized participants with plasma sodium lower than 130 mmol/L and randomized 2173 patients overall. The targeted correction group included 1079 patients, and 1094 received routine care. Median age was 73 years, 48% were male, and baseline sodium was 127 mmol/L in both groups.

The primary outcome was the combined risk of death or rehospitalization within 30 days after inclusion. It occurred in 20.5% of patients receiving targeted correction, or 218 of 1065, and in 21.8% receiving routine care, or 234 of 1073. The estimated absolute difference was -1.3 percentage points, with a 95% confidence interval from -4.9 to 2.2 and a P value of 0.45. Death occurred in 8.0% in each group, while rehospitalization occurred in 13.2% versus 14.1%, and the composite outcome was not significantly different.

Normonatremia was defined as a plasma sodium concentration of 135 to 145 mmol/L. During treatment, 641 of 1065 patients in the targeted group reached that range, compared with 492 of 1073 in routine care. The mean maximum absolute sodium change was 10.0 mmol/L with targeted correction and 8.7 mmol/L with routine care. These findings showed more frequent sodium normalization without a corresponding change in the 30-day composite endpoint.

Overcorrection occurred in 25 patients, or 2.3%, with targeted correction and in 16 patients, or 1.4%, with routine care. No cases of osmotic demyelination syndrome were observed in either group. Better sodium normalization was reported without a significant reduction in the combined 30-day risk of death or rehospitalization.