A Randomized Trial of Empagliflozin to Increase Plasma Sodium Levels in Patients with the Syndrome of Inappropriate Antidiuresis
Abstract
Significance Statement Treatment options for the syndrome of inappropriate antidiuresis (SIAD), the predominant cause of hyponatremia, are inadequate. The authors studied the effects of the sodium glucose cotransporter 2 inhibitor empagliflozin, which promotes osmotic diuresis via urinary glucose excretion, in a randomized trial of 87 hospitalized patients with SIAD-induced hyponatremia who were also treated with standard fluid restriction. Patients who received 4 days of empagliflozin had a significantly larger increase in plasma sodium compared with those who received placebo (10 versus 7 mmol/L, respectively). Profound hyponatremia (<125 mmol/L) and lower baseline osmolality levels increased the likelihood of response to treatment with empagliflozin. These findings suggest that further investigation of empagliflozin as a treatment option for hospitalized patients with SIAD-induced hyponatremia is warranted. Background Treatment options to address the hyponatremia induced by the syndrome of inappropriate antidiuresis (SIAD) are inadequate. The sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin promotes osmotic diuresis via urinary glucose excretion and therefore, might offer a novel treatment option for SIAD. Methods In this double-blind, randomized trial, we recruited 88 hospitalized patients with SIAD-induced hyponatremia <130 mmol/L at the University Hospital Basel from September 2016 until January 2019 and assigned patients to receive, in addition to…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 88 participants or records.
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