Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia

Abstract

The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has pub-lished a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evi-dence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representa-tive experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recom-mendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid inter-mittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualiza-tion of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospi-talized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.