Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements

BMC Medicine

Raymond Vanholder⁵  Angela C Webster¹  Wim Van Biesen⁵  Ionut Nistor⁴  Sabine N van der Veer³  Jill Vanmassenhove⁵  Evi V Nagler² 

[1] Centre for Transplant and Renal Research, The University of Sydney at Westmead Hospital, Westmead 2145, NSW, Australia;Centre for Kidney Research, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia;Department of Medical Informatics, Academic Medical Center, Amsterdam 1100, DD, the Netherlands;Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Strada Universitãtii 16, Iasi 700115, Romania;Renal Division, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium

关键词: Systematic review;    Hyponatremia;    Clinical practice guideline;   

Others  :  1118051
DOI  :  10.1186/s12916-014-0231-1

 received in 2014-04-20, accepted in 2014-11-07,  发布年份 2014

【 摘 要 】

Background

Hyponatremia is a common electrolyte disorder. Multiple organizations have published guidance documents to assist clinicians in managing hyponatremia. We aimed to explore the scope, content, and consistency of these documents.

Methods

We searched MEDLINE, EMBASE, and websites of guideline organizations and professional societies to September 2014 without language restriction for Clinical Practice Guidelines (defined as any document providing guidance informed by systematic literature review) and Consensus Statements (any other guidance document) developed specifically to guide differential diagnosis or treatment of hyponatremia. Four reviewers appraised guideline quality using the 23-item AGREE II instrument, which rates reporting of the guidance development process across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Total scores were calculated as standardized averages by domain.

Results

We found ten guidance documents; five clinical practice guidelines and five consensus statements. Overall, quality was mixed: two clinical practice guidelines attained an average score of >50% for all of the domains, three rated the evidence in a systematic way and two graded strength of the recommendations. All five consensus statements received AGREE scores below 60% for each of the specific domains.

The guidance documents varied widely in scope. All dealt with therapy and seven included recommendations on diagnosis, using serum osmolality to confirm hypotonic hyponatremia, and volume status, urinary sodium concentration, and urinary osmolality for further classification of the hyponatremia. They differed, however, in classification thresholds, what additional tests to consider, and when to initiate diagnostic work-up. Eight guidance documents advocated hypertonic NaCl in severely symptomatic, acute onset (<48 h) hyponatremia. In chronic (>48 h) or asymptomatic cases, recommended treatments were NaCl 0.9%, fluid restriction, and cause-specific therapy for hypovolemic, euvolemic, and hypervolemic hyponatremia, respectively. Eight guidance documents recommended limits for speed of increase of sodium concentration, but these varied between 8 and 12 mmol/L per 24 h. Inconsistencies also existed in the recommended dose of NaCl, its initial infusion speed, and which second line interventions to consider.

Conclusions

Current guidance documents on the assessment and treatment of hyponatremia vary in methodological rigor and recommendations are not always consistent.

【 授权许可】

   
2014 Nagler et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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