PMID- 27082573
OWN - NLM
STAT- MEDLINE
DCOM- 20160831
LR  - 20210109
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 95
IP  - 15
DP  - 2016 Apr
TI  - Efficacy and Safety of Vasopressin Receptor Antagonists for Euvolemic or 
      Hypervolemic Hyponatremia: A Meta-Analysis.
PG  - e3310
LID - 10.1097/MD.0000000000003310 [doi]
LID - e3310
AB  - Hyponatremia, defined as a nonartifactual serum sodium level <135 mmol/L, is the 
      most common fluid and electrolyte abnormality in clinical practice. Traditional 
      managements (fluid restriction, hypertonic saline and loop diuretics, etc.) are 
      difficult to maintain or ineffective. Recently, vasopressin receptor antagonists 
      (VRAs) have shown promise for the treatment of hyponatremia. We aimed to conduct 
      a meta-analysis to evaluate the efficacy and safety of VRAs in patients with 
      euvolemic or hypervolemic hyponatremia. We searched Pubmed, Cochrane Library, Web 
      of Science and Springer, etc. (latest search on June 4, 2015) for English 
      publications with randomized controlled trials. Two authors independently 
      screened the citations and extracted data. We calculated pooled relative risk 
      (RR), risk difference (RD), weighted mean difference (WMD) or standard mean 
      difference (SMD), and 95% confidence intervals (CIs) by using random and fixed 
      effect models. We collected data from 18 trials involving 1806 patients. Both 
      random and fixed effect meta-analyses showed that VRAs significantly increased 
      the net change of serum sodium concentration (WMD(random) = 4.89 mEq/L, 
      95%CIs = 4.35-5.43 and WMD(fixed) = 4.70 mEq/L, 95%CIs = 4.45-4.95), response 
      rate (RR(random )= 2.77, 95%CIs = 2.29-3.36 and RR(fixed) = 2.95, 
      95%CIs = 2.56-3.41), and 24-hour urine output (SMD(random) = 0.82, 
      95%CIs = 0.65-1.00 and SMD(fixed) = 0.79, 95%CIs = 0.66-0.93) compared to 
      placebo. Furthermore, VRAs significantly decreased body weight 
      (WMD(random) = -0.87 kg, 95%CIs = -1.24 to -0.49 and WMD(fixed) = -0.91 kg, 
      95%CIs = -1.22 to -0.59). In terms of safety, rates of drug-related adverse 
      events (AEs), rapid sodium level correction, constipation, dry mouth, thirst, and 
      phlebitis in the VRA-treated group were greater than those in control group. 
      However, there was no difference in the total number of AEs, discontinuations due 
      to AEs, serious AEs, death, headache, hypotension, nausea, anemia, hypernatremia, 
      urinary tract infection, renal failure, pyrexia, upper gastrointestinal bleeding, 
      diarrhea, vomiting, peripheral edema, and dizziness between the 2 groups. Random 
      effect meta-analyses showed that post treatment urine osmolality, supine systolic 
      blood pressure, and diastolic blood pressure were lowered 
      (WMD(random) = -233.07 mOsmol/kg, 95%CIs = -298.20-147.94; 
      WMD(random) = -6.11 mmHg, 95%CIs = -9.810 to -2.41; WMD(random )= -2.59 mmHg, 
      95%CIs = -4.06 to -1.11, respectively), but serum osmolality was increased 
      (WMD(random) = 9.29 mOsmol/kg, 95%CIs = 5.56-13.03). There was no significant 
      change from baseline in serum potassium concentration between the 2 groups 
      (WMD(fixed) = 0.00 mmHg, 95%CIs = -0.07-0.06). VRAs are relatively effective and 
      safe for the treatment of hypervolemic and euvolemic hyponatremia.
FAU - Zhang, Xiangyun
AU  - Zhang X
AD  - From the Department of Clinical Pharmacy (XZ, MZ, WD, DZ, RX, JY), Shenyang 
      Pharmaceutical University; and Department of Gastroenterology (YS), Hospital 463 
      of Peoples Liberation Army, Shenyang, China.
FAU - Zhao, Mingyi
AU  - Zhao M
FAU - Du, Wei
AU  - Du W
FAU - Zu, Dongni
AU  - Zu D
FAU - Sun, Yingwei
AU  - Sun Y
FAU - Xiang, Rongwu
AU  - Xiang R
FAU - Yang, Jingyu
AU  - Yang J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antidiuretic Hormone Receptor Antagonists)
SB  - IM
MH  - Antidiuretic Hormone Receptor Antagonists/*pharmacology
MH  - Humans
MH  - *Hyponatremia/diagnosis/drug therapy/etiology/physiopathology
MH  - Treatment Outcome
MH  - Water-Electrolyte Balance/*drug effects
PMC - PMC4839817
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2016/04/16 06:00
MHDA- 2016/09/01 06:00
PMCR- 2016/04/18
CRDT- 2016/04/16 06:00
PHST- 2016/04/16 06:00 [entrez]
PHST- 2016/04/16 06:00 [pubmed]
PHST- 2016/09/01 06:00 [medline]
PHST- 2016/04/18 00:00 [pmc-release]
AID - 00005792-201604120-00036 [pii]
AID - 10.1097/MD.0000000000003310 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2016 Apr;95(15):e3310. doi: 10.1097/MD.0000000000003310.