ACS 2018: Risk Factors for Desmopressin-Induced Hyponatremia

Boston, Massachusetts ( William N. Harris and colleagues aimed to identify new risk factors for desmopressin-induced hyponatremia in nocturia treatment. They evaluated the pooled data from six randomized controlled trials and the corresponding published results.
A total of 1,443 patients, 820 (57%) men, and 623 (43%) women, with an average age of 61.1 years were evaluated. Stepwise logistic regression and Cox proportional hazards were utilized. A p-value of <0.1 kept factors in the model. Final logistic regressions and final Cox proportional hazards identified the most important factors.

They found dyspnea, gastrointestinal illness, and angina pectoris emerged as previously unrecognized significant risk factors for the development of desmopressin-related hyponatremia. Gastrointestinal illness (OR 2.29, 95% CI 1.24-4.22, P=0.009) emerged as a potential risk factor for sodium levels <130 mmol/l. When pooled across genders, desmopressin doses of 50 μg (OR 3.07, 95% CI 1.46-6.47, P=0.0004) and 100 μg (OR 3.91, 95% CI 1.90-8.05, P<0.0001) were additional risk factors, with females being more at risk (HR 2.37, 95% CI 1.24, 4.56, P=0094) and thus requiring lower doses than males (ratio of 2:1). Thiazide diuretics (OR 5.05, 95% CI 1.18-21.62, P=0.029) and angina pectoris (OR 12.6, 95% CI 2.50-63.43, P=0.002) were significantly associated with serum sodium drop ≥7. Dyspnea was a significant risk factor for developing serum sodium <130 mmol/l using Cox proportional hazards (HR 14.28, 95% CI 8.40-24.27, P<0.0001).

In summary, they found an association of hyponatremia in desmopressin-treated patients with antecedent gastrointestinal illnesses, dyspnea, and angina pectoris. Further investigation in a larger number of patients and heterogeneous population to enhance the generalizability is warranted to identify the mechanisms behind these observations.

Presented By: William N. Harris, University of Ghent, Ghent, Belgium

Written By: Stephen B. Williams, M.D., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts