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Abstract: PO2174

Hyponatremia Is Common After Indwelling Catheter Drainage of Malignant Ascites

Session Information

  • Onco-Nephrology - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Tio, Maria Clarissa, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Gutowski, Emily Deena, Harvard Medical School, Boston, Massachusetts, United States
  • Stecker, Michael S., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Verma, Ashish, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Motwani, Shveta S., Dana-Farber/Children's Hospital Cancer Center, Boston, Massachusetts, United States
  • Mount, David B., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McMahon, Gearoid M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
Background

Indwelling peritoneal catheters (IPCs) are frequently used to drain tense, symptomatic, malignancy-related ascites. Large-volume drainage may lead to hyponatremia due to massive salt depletion. To date, no studies have examined the epidemiology of hyponatremia after IPC placement.

Methods

We retrospectively reviewed the charts of 461 patients who had IPCs placed between 2006 and 2016 at a tertiary care hospital. Among the 309 patients with labs available pre- and post-catheter, we studied the incidence of hyponatremia and its risk factors. We also examined the management of hyponatremia and its association with mortality.

Results

The overall incidence of hyponatremia post-IPC placement was 85%, of whom 8% had severe hyponatremia with a serum sodium (sNa) sNa<120 mEq/L. The mean decline in sNa pre- versus post-catheter was 5 mEq/L (+/- 5.1) and fell by ≥10 mEq/L among 52 patients (16.8%). Patients with hyponatremia prior to catheter placement had an 8-fold (95% CI, 2.9-21.7) higher adjusted odds of having persistent hyponatremia post-catheter (Table 1). Patients with hepato-pancreatic-biliary malignancies and lower BMI also had a higher adjusted odds of hypoonatremia. Hyponatremia was either unrecognized or untreated in 61% of patients. Patients who had sNa ≤120 mEq/L had shorter median survival compared with those with a post-IPC sNa>120 mEq/L (8 versus 17 days, log-rank p value = 0.03) (Figure 1).

Conclusion

Though IPC placement is often a palliative measure, hyponatremia is common, and severe hyponatremia may be associated with shorter survival. These patients may warrant closer monitoring post-catheter placement.

Table 1: Predictors of Hyponatremia Post-IPC
VariableUnivariable AnalysisMultivariable Analysis
 OR (95% CI)OR (95% CI)
Age >600.58 (0.31,1.09)0.60 (0.23, 1.57)
Hepato-Pancreato-Biliary Cancer2.42 (1.05,5.60)5.09 (1.05, 24.80)
BMI (continuous)0.80 (0.83, 0.98)0.90 (0.82, 0.99)
Sodium <1135 Pre-IPC6.88 (3.39,13.95)7.87 (2.86,21.70)

Funding

  • Other NIH Support