ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO1030

The Role of Desmopressin in the Management of Severe Hypovolemic Hyponatremia

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 702 Water/Urea/Vasopressin, Organic Solutes

Authors

  • Ward, Frank, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
  • Naimark, David M., Sunnybrook Health Science Centre, Toronto, Ontario, Canada
Background

The role of desmopressin (DDAVP) to prevent or treat rapid serum sodium concentration ([Na]s) correction during hyponatremia management remains unclear. The study aim was to assess DDAVP use during the first 48-hours of severe, hypovolemic hyponatremia management. The primary study hypothesis was that the use of DDAVP would slow the rate of [Na]s correction compared to those not receiving DDAVP.

Methods

A retrospective, observational study was conducted in a single, tertiary centre of all patients managed for severe, hypovolemic hyponatremia over a 12-month period. Inclusion criteria were [Na]s <125mmol/l at referral, serum osmolality <275mOsm/kg, urine sodium <30mmol/l and urine osmolality >100mOsm/kg. Patients with signs of extra-cellular fluid compartment overload were excluded. The primary outcome measure was [Na]S correction during the first 48-hours, compared between patients who did or did not receive DDAVP using linear regression.

Results

Twenty-eight patients were identified, with baseline mean [Na]s of 112.7±6.6mmol/l vs 117±4.3mmol/l (p=0.06) in those who received (n=16) and did not receive DDAVP (n=12), respectively. The DDAVP group had a more rapid [Na]s correction on the first day compared to those who did not receive DDAVP, 7.7±3.8mmol/l/day vs 5.1±2.0mmol/l/day (p=0.04). On the second day, there was a similar rate of [Na]s correction for those receiving DDAVP and those who did not, 1.3±4.3mmol/l/day vs 2.6±3.2mmol/l/day (p=0.39). Overall, there was no difference in [Na]s correction after 48-hours between those who received DDAVP and those who did not, 121.7±7.5mmol/l vs 124.8±5.7mmol/l (p=0.24). Patients who had experienced an over-correction were successfully treated with DDAVP (n=5), so that no patient had an ongoing over-correction by 48-hours. The final [Na]s for patients who received a single dose of DDAVP (n=7) was similar to those who received multiple doses (n=9), 123.8±5.8mmol/l vs 120±8.5mmol/l, p=0.32.

Conclusion

DDAVP appears safe and effective in the management of severe, hypovolemic hyponatremia, associated with similar [Na]s correction to those who did not receive DDAVP after 48-hours, despite an initial more rapid correction. A single dose of DDAVP may be as effective as multiple doses. A randomized trial should examine what benefit DDAVP confers in addition to standard care in the management of severe, hypovolemic hyponatremia.