Abstract: TH-PO0068
Early Intravenous Desmopressin Is Associated with Lower Mortality in Hospitalized Patients with Hyponatremia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Ismail, Ibrahim, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Nachman, Patrick H., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Safadi, Sami, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background
Hyponatremia is a common electrolyte disorder among hospitalized patients and independently predicts morbidity and death. Desmopressin is administered in severe hyponatremia to control the rate of sodium correction and reduce the risk of osmotic demyelination syndrome, but its association with patient survival remains uncertain.
Methods
Retrospective cohort study of a validated hyponatremia disease cohort from an acute-care data warehouse (January 2011-June 2024; 23,629 encounters; 17,600 unique patients). The exposure was IV desmopressin administered within the first 24 hours of admission. The primary outcome was one-year all-cause mortality, analyzed with log-rank test and Cox proportional hazards models (unadjusted; adjusted for age, sex, admission sodium, and Δ sodium at 24 h).
Results
Day-1 IV desmopressin was administered in 164 encounters (0.7%). Patients in this group had lower admission sodium than comparators (median 116 mEq/L, IQR 112-120), consistent with more severe baseline hyponatremia. Δ sodium at 24 hours was +7 mEq/L (IQR 4-9), which while larger than the comparator group, is within guideline-recommended safe correction limits. One-year survival was higher in the day-1 IV desmopressin group (unadjusted HR 0.41, 95% CI 0.26-0.65, p<0.001). After adjustment for age, sex, admission sodium, and Δ sodium at 24 h, the association persisted (HR 0.41, 95% CI 0.22-0.76, p=0.005).
Conclusion
In this large hyponatremia cohort, early IV desmopressin was associated with lower one-year mortality, and sodium correction rates remained within safe limits despite more severe baseline hyponatremia. Residual confounding by indication such as unmeasured differences in care intensity, and hyponatremia etiology is a main limitation. Prospective randomized trials are needed to establish whether early IV desmopressin improves survival or marks a pattern of high-intensity hyponatremia management.
One Year Survival by Day 1 IV Desmopressin Use