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Original ArticlesAcid/Base and Electrolyte Disorders
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Urea for the Treatment of Hyponatremia

Helbert Rondon-Berrios, Srijan Tandukar, Maria K. Mor, Evan C. Ray, Filitsa H. Bender, Thomas R. Kleyman and Steven D. Weisbord
CJASN November 2018, 13 (11) 1627-1632; DOI: https://doi.org/10.2215/CJN.04020318
Helbert Rondon-Berrios
1Renal-Electrolyte Division, Department of Medicine,
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Srijan Tandukar
1Renal-Electrolyte Division, Department of Medicine,
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Maria K. Mor
2Department of Biostatistics, Graduate School of Public Health, and
3Center for Health Equity Research and Promotion and
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Evan C. Ray
1Renal-Electrolyte Division, Department of Medicine,
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Filitsa H. Bender
1Renal-Electrolyte Division, Department of Medicine,
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Thomas R. Kleyman
1Renal-Electrolyte Division, Department of Medicine,
4Departments of Cell Biology and
5Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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Steven D. Weisbord
1Renal-Electrolyte Division, Department of Medicine,
3Center for Health Equity Research and Promotion and
6Renal Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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    Figure 1.

    Increase in plasma sodium (Na) from baseline to the completion of therapy among urea only–treated patients.

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    Table 1.

    Baseline characteristics of patients admitted to the University of Pittsburgh Medical Center with hyponatremia and treated with urea between July 2016 and August 2017

    CharacteristicN=58
    Demographic characteristics
     Median age [IQR], yr68 [55–79]
     Men, N (%)35 (60.3)
    Clinical and treatment characteristics
     Etiology of hyponatremia, N (%)
      SIADHb47 (81)
       Medications18 (31)
       Idiopathic13 (22)
       Intracranial disorders13 (22)
       Malignancy10 (17)
       Pulmonary disorders8 (14)
       Pain7 (12)
       Other2 (3)
      Thiazide diuretics7 (12)
      Heart failure6 (10)
      Hypovolemia6 (10)
      Kidney disease4 (7)
      Adrenal insufficiency2 (3)
      Cirrhosis1 (2)
     Other therapies for hyponatremia, N (%)
      Fluid restriction51 (88)
      Sodium chloride tablets22 (38)
      Loop diuretics19 (33)
      Normal saline12 (21)
      Vasopressin antagonists6 (10)
      Hypertonic saline 3%4 (7)
      Potassium chloride tablets3 (5)
      Glucocorticoids1 (2)
    • Etiologies of hyponatremia and therapies for hyponatremia are not mutually exclusive. IQR, interquartile range; SIADH, syndrome of inappropriate antidiuretic hormone secretion.

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    Table 2.

    Baseline and post-treatment laboratory parameters among urea only–treated patients

    Laboratory ParameterBaseline24 hEnd of Therapy
    Plasma sodium, mEq/L125 [122–127]127 [124–129]; P=0.02131 [129–136]; P=0.001
    BUN, mg/dl16 [10–20]24 [20–35]; P=0.00142 [26–53]; P<0.001
    Serum creatinine, mg/dl0.8 [0.75–1]0.8 [0.75–1]; P=0.910.9 [0.75–1]; P=0.59
    Urine osmolality, mOsm/kg365 [361–561]a450 [359–522.5]b; P=0.12546 [542–602]c; P=0.13
    Urine sodium, mEq/L75 [42–105]aNA50 [37–76]c; P=0.06
    • Data are presented as median [interquartile range]. P values represent comparison with baseline values. NA, not available.

    • ↵a One missing value.

    • ↵b Eight missing values.

    • ↵c Seven missing values.

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    Table 3.

    Comparison of outcomes between urea only–treated and urea-untreated patients

    OutcomeUrea-Only Treated, n=12Urea Untreated, n=12P Value
    Baseline plasma sodium125 [122–127]123 [121–125]NA
    Change in plasma sodium by 24 h, mEq/L2.5 [0–4.5]−0.5 [−2.5 to 1.5]0.04
    Change in plasma sodium by end of therapy, mEq/L6 [3.5–10]5.5 [3–7.5]0.51
    Normalization of plasma sodium, N (%)4 (33)1 (8)0.08
    LOS, d6 [3.5–7]6 [4–6]0.74
    • Data are presented as median [interquartile range] or N (%). NA, not applicable, because urea-treated and untreated patients were matched for baseline plasma sodium; LOS, length of hospital stay.

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Clinical Journal of the American Society of Nephrology: 13 (11)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 11
November 07, 2018
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Urea for the Treatment of Hyponatremia
Helbert Rondon-Berrios, Srijan Tandukar, Maria K. Mor, Evan C. Ray, Filitsa H. Bender, Thomas R. Kleyman, Steven D. Weisbord
CJASN Nov 2018, 13 (11) 1627-1632; DOI: 10.2215/CJN.04020318

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Urea for the Treatment of Hyponatremia
Helbert Rondon-Berrios, Srijan Tandukar, Maria K. Mor, Evan C. Ray, Filitsa H. Bender, Thomas R. Kleyman, Steven D. Weisbord
CJASN Nov 2018, 13 (11) 1627-1632; DOI: 10.2215/CJN.04020318
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