Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and ...

Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and management of hyponatremia Yeonhee Lee1, Kyung Don Yoo2, Seon Ha Baek3, Yang Gyun Kim4, Hyo Jin Kim5, Ji Young Ryu3, Jin Hyuk Paek6, Sang Heon Suh7, Se Won Oh8, Jeonghwan Lee9, Jong Hyun Jhee10, Jin-Soon Suh11, Eun Mi Yang12, Young Ho Park13, Yae Lim Kim14, Miyoung Choi15, Kook-Hwan Oh16, Sejoong Kim17, and on behalf of the Hyponatremia Guideline Development Group 1Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
2Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
3Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
4Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
5Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
6Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
7Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
8Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
9Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
10Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
11Division of Pediatric Nephrology, Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
12Division of Pediatric Nephrology, Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
13Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
14Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
15Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Korea
16Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
17Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Abstract The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative 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 recommendation 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 intermittent 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 individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized 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. Keywords: Hyponatremia ; Evidence-based practice ; GRADE approach ; Guideline ; Recommendation

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