Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis
The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these que...
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| creator | Chander, Subhash Kumari, Roopa Lohana, Abhi Chand Rahaman, Zubair Parkash, Om Shiwlani, Sheena Mohammed, Yaqub Nadeem Wang, Hong Yu Chi, Hao Tan, Wenchy Kumar, Sanjay Kirshan Sindhu, FNU |
| description | The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these questions.
This PRISMA-guided study examined published research across 4 electronic databases.
Patients with SIADH-related hyponatremia.
Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.
Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.
A meta-analysis was conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity.
Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P |
| doi_str_mv | 10.1053/j.ajkd.2024.07.011 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3112856898</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0272638624009843</els_id><sourcerecordid>3112856898</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1525-c7de3c78ab392d7d30db6e9a25908e37f633e787ac6ba3ee2fba14490ebf708f3</originalsourceid><addsrcrecordid>eNp9kE1v1DAYhC1ERZfCH-CAfOSS4I-N7SAuq_KxlVoh0fZsOfYbycvGXmyHao_95zjawrGnkfzOjDwPQu8oaSnp-Mdda3a_XMsIW7dEtoTSF2hFO8Ybobh6iVaESdYIrsQ5ep3zjhDScyFeoXNelfG-W6HH-wQGl4jvqha8PR5iMCXB5A3-MsNyuT0Gl-IEOI74KpjDIcVD8qYA3oTinZ8TFG_xNqYpBsC3YJeHGD7hTc3mApNZ7j_hj4cHbILDN1BMswlmf8w-v0Fno9lnePukF-j-29e7y21z_eP71eXmurF1UtdY6YBbqczAe-ak48QNAnrDup4o4HIUnINU0lgxGA7AxsHQ9bonMIySqJFfoA-n3vr_3zPkoiefLez3JkCcs-aUMtUJ1atqZSerTTHnBKOugyeTjpoSvaDXO72g1wt6TaSu6Gvo_VP_PEzg_kf-sa6GzycD1JWVRdLZeggWnE9gi3bRP9f_F7sdluk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3112856898</pqid></control><display><type>article</type><title>Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis</title><source>Elsevier ScienceDirect Journals Complete</source><creator>Chander, Subhash ; Kumari, Roopa ; Lohana, Abhi Chand ; Rahaman, Zubair ; Parkash, Om ; Shiwlani, Sheena ; Mohammed, Yaqub Nadeem ; Wang, Hong Yu ; Chi, Hao ; Tan, Wenchy ; Kumar, Sanjay Kirshan ; Sindhu, FNU</creator><creatorcontrib>Chander, Subhash ; Kumari, Roopa ; Lohana, Abhi Chand ; Rahaman, Zubair ; Parkash, Om ; Shiwlani, Sheena ; Mohammed, Yaqub Nadeem ; Wang, Hong Yu ; Chi, Hao ; Tan, Wenchy ; Kumar, Sanjay Kirshan ; Sindhu, FNU</creatorcontrib><description>The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these questions.
This PRISMA-guided study examined published research across 4 electronic databases.
Patients with SIADH-related hyponatremia.
Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.
Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.
A meta-analysis was conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity.
Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P<0.01) and urea (MD, 31.66 [95% CI, 16.05-47.26], P<0.01) in patients with SIADH, albeit with significantly high heterogeneity. Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours and 2, 5, 7, and 14 days, as well as after 1 year of treatment. Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) (MD, 18.04 [95% CI, 13.68-22.39]) than with moderate (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) or mild (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH-induced hyponatremia. Urea treatment was comparable to fluid restriction (MD, 0.81 [95% CI, −0.93 to 2.55], P = 0.4) and vaptans (MD, −1.96 [95% CI, −4.59 to 0.66], P=0.1) but superior to no treatment (MD, 7.99 [95% CI, 6.25-9.72], P<0.01). Urea was associated with minor adverse events, with poor palatability being the most common.
As no randomized controlled trials investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies.
Urea is safe and effective for managing SIADH-induced hyponatremia. These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.
Registered at PROSPERO with study number CRD42024511685.</description><identifier>ISSN: 0272-6386</identifier><identifier>ISSN: 1523-6838</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2024.07.011</identifier><identifier>PMID: 39362395</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Diuresis ; euvolemia ; hyponatremia ; serum sodium ; SIADH</subject><ispartof>American journal of kidney diseases, 2024-10</ispartof><rights>2024 National Kidney Foundation, Inc.</rights><rights>Copyright © 2024 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1525-c7de3c78ab392d7d30db6e9a25908e37f633e787ac6ba3ee2fba14490ebf708f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39362395$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chander, Subhash</creatorcontrib><creatorcontrib>Kumari, Roopa</creatorcontrib><creatorcontrib>Lohana, Abhi Chand</creatorcontrib><creatorcontrib>Rahaman, Zubair</creatorcontrib><creatorcontrib>Parkash, Om</creatorcontrib><creatorcontrib>Shiwlani, Sheena</creatorcontrib><creatorcontrib>Mohammed, Yaqub Nadeem</creatorcontrib><creatorcontrib>Wang, Hong Yu</creatorcontrib><creatorcontrib>Chi, Hao</creatorcontrib><creatorcontrib>Tan, Wenchy</creatorcontrib><creatorcontrib>Kumar, Sanjay Kirshan</creatorcontrib><creatorcontrib>Sindhu, FNU</creatorcontrib><title>Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these questions.
This PRISMA-guided study examined published research across 4 electronic databases.
Patients with SIADH-related hyponatremia.
Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.
Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.
A meta-analysis was conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity.
Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P<0.01) and urea (MD, 31.66 [95% CI, 16.05-47.26], P<0.01) in patients with SIADH, albeit with significantly high heterogeneity. Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours and 2, 5, 7, and 14 days, as well as after 1 year of treatment. Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) (MD, 18.04 [95% CI, 13.68-22.39]) than with moderate (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) or mild (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH-induced hyponatremia. Urea treatment was comparable to fluid restriction (MD, 0.81 [95% CI, −0.93 to 2.55], P = 0.4) and vaptans (MD, −1.96 [95% CI, −4.59 to 0.66], P=0.1) but superior to no treatment (MD, 7.99 [95% CI, 6.25-9.72], P<0.01). Urea was associated with minor adverse events, with poor palatability being the most common.
As no randomized controlled trials investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies.
Urea is safe and effective for managing SIADH-induced hyponatremia. These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.
Registered at PROSPERO with study number CRD42024511685.</description><subject>Diuresis</subject><subject>euvolemia</subject><subject>hyponatremia</subject><subject>serum sodium</subject><subject>SIADH</subject><issn>0272-6386</issn><issn>1523-6838</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v1DAYhC1ERZfCH-CAfOSS4I-N7SAuq_KxlVoh0fZsOfYbycvGXmyHao_95zjawrGnkfzOjDwPQu8oaSnp-Mdda3a_XMsIW7dEtoTSF2hFO8Ybobh6iVaESdYIrsQ5ep3zjhDScyFeoXNelfG-W6HH-wQGl4jvqha8PR5iMCXB5A3-MsNyuT0Gl-IEOI74KpjDIcVD8qYA3oTinZ8TFG_xNqYpBsC3YJeHGD7hTc3mApNZ7j_hj4cHbILDN1BMswlmf8w-v0Fno9lnePukF-j-29e7y21z_eP71eXmurF1UtdY6YBbqczAe-ak48QNAnrDup4o4HIUnINU0lgxGA7AxsHQ9bonMIySqJFfoA-n3vr_3zPkoiefLez3JkCcs-aUMtUJ1atqZSerTTHnBKOugyeTjpoSvaDXO72g1wt6TaSu6Gvo_VP_PEzg_kf-sa6GzycD1JWVRdLZeggWnE9gi3bRP9f_F7sdluk</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Chander, Subhash</creator><creator>Kumari, Roopa</creator><creator>Lohana, Abhi Chand</creator><creator>Rahaman, Zubair</creator><creator>Parkash, Om</creator><creator>Shiwlani, Sheena</creator><creator>Mohammed, Yaqub Nadeem</creator><creator>Wang, Hong Yu</creator><creator>Chi, Hao</creator><creator>Tan, Wenchy</creator><creator>Kumar, Sanjay Kirshan</creator><creator>Sindhu, FNU</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20241001</creationdate><title>Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis</title><author>Chander, Subhash ; Kumari, Roopa ; Lohana, Abhi Chand ; Rahaman, Zubair ; Parkash, Om ; Shiwlani, Sheena ; Mohammed, Yaqub Nadeem ; Wang, Hong Yu ; Chi, Hao ; Tan, Wenchy ; Kumar, Sanjay Kirshan ; Sindhu, FNU</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1525-c7de3c78ab392d7d30db6e9a25908e37f633e787ac6ba3ee2fba14490ebf708f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Diuresis</topic><topic>euvolemia</topic><topic>hyponatremia</topic><topic>serum sodium</topic><topic>SIADH</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chander, Subhash</creatorcontrib><creatorcontrib>Kumari, Roopa</creatorcontrib><creatorcontrib>Lohana, Abhi Chand</creatorcontrib><creatorcontrib>Rahaman, Zubair</creatorcontrib><creatorcontrib>Parkash, Om</creatorcontrib><creatorcontrib>Shiwlani, Sheena</creatorcontrib><creatorcontrib>Mohammed, Yaqub Nadeem</creatorcontrib><creatorcontrib>Wang, Hong Yu</creatorcontrib><creatorcontrib>Chi, Hao</creatorcontrib><creatorcontrib>Tan, Wenchy</creatorcontrib><creatorcontrib>Kumar, Sanjay Kirshan</creatorcontrib><creatorcontrib>Sindhu, FNU</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chander, Subhash</au><au>Kumari, Roopa</au><au>Lohana, Abhi Chand</au><au>Rahaman, Zubair</au><au>Parkash, Om</au><au>Shiwlani, Sheena</au><au>Mohammed, Yaqub Nadeem</au><au>Wang, Hong Yu</au><au>Chi, Hao</au><au>Tan, Wenchy</au><au>Kumar, Sanjay Kirshan</au><au>Sindhu, FNU</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2024-10-01</date><risdate>2024</risdate><issn>0272-6386</issn><issn>1523-6838</issn><eissn>1523-6838</eissn><abstract>The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these questions.
This PRISMA-guided study examined published research across 4 electronic databases.
Patients with SIADH-related hyponatremia.
Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.
Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.
A meta-analysis was conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity.
Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P<0.01) and urea (MD, 31.66 [95% CI, 16.05-47.26], P<0.01) in patients with SIADH, albeit with significantly high heterogeneity. Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours and 2, 5, 7, and 14 days, as well as after 1 year of treatment. Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) (MD, 18.04 [95% CI, 13.68-22.39]) than with moderate (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) or mild (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH-induced hyponatremia. Urea treatment was comparable to fluid restriction (MD, 0.81 [95% CI, −0.93 to 2.55], P = 0.4) and vaptans (MD, −1.96 [95% CI, −4.59 to 0.66], P=0.1) but superior to no treatment (MD, 7.99 [95% CI, 6.25-9.72], P<0.01). Urea was associated with minor adverse events, with poor palatability being the most common.
As no randomized controlled trials investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies.
Urea is safe and effective for managing SIADH-induced hyponatremia. These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.
Registered at PROSPERO with study number CRD42024511685.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39362395</pmid><doi>10.1053/j.ajkd.2024.07.011</doi></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Diuresis euvolemia hyponatremia serum sodium SIADH |
| title | Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis |
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