Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis.

This systematic reviewand meta-analysisof observational studies addresses these questions.

这项观察性研究的系统评价和荟萃分析解决了这些问题。

study_design

This PRISMA-guided study examined published research across 4 electronic databases.

这项遵循PRISMA指南的研究检查了4个电子数据库中发表的研究。

study_populations

Patients with SIADH-related hyponatremia.

患有与抗利尿激素分泌异常综合征（SIADH）相关的低钠血症的患者。

selection_criteria

Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.

报告至少1项与血清钠浓度、症状缓解或口服或鼻胃管尿素给药后不良反应相关的临床试验和观察性研究。

data_extraction

Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.

2名评审员独立使用标准化表格记录研究特征、参与者人口统计学、干预细节和治疗结果进行数据提取。

analytical_approach

A meta-analysiswas conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities.

采用限制性最大似然法对随机效应模型进行荟萃分析，以评估尿素治疗对血清钠和血清尿素的影响，与其他治疗方式相比较。

Subgroup analyses were conducted based on treatment duration and SIADH severity.

根据治疗持续时间和SIADH严重程度进行了亚组分析。

Results

Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P<0.01) and urea (MD, 31.66 [95% CI, 16.05-47.26], P<0.01) in patients with SIADH, albeit with significantly high heterogeneity.

尿素治疗显著提高了SIADH患者的血清钠水平（平均差异[MD]，9.08 [95% 置信区间, 7.64-10.52]，P<0.01）和尿素水平（MD, 31.66 [95% 置信区间, 16.05-47.26]，P<0.01），尽管存在显著的异质性。

Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours and 2, 5, 7, and 14 days, as well as after 1 year of treatment.

基于治疗时长的亚组分析显示，在治疗24小时后以及2天、5天、7天、14天和1年后，血清钠水平显著上升。

Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) (MD, 18.04 [95% CI, 13.68-22.39]) than with moderate (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) or mild (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH-induced hyponatremia.

在使用尿素治疗后，血清钠水平在严重 (<120 mEq/L) 患者中增加的幅度更大 (MD, 18.04 [95% CI, 13.68-22.39])，与中度 (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) 或轻度 (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH引起的低钠血症相比。

Urea treatment was comparable to fluid restriction (MD, 0.81 [95% CI, -0.93 to 2.55], P = 0.4) and vaptans (MD, -1.96 [95% CI, -4.59 to 0.66], P=0.1) but superior to no treatment (MD, 7.99 [95% CI, 6.25-9.72], P<0.01).

尿素治疗与限液疗法相当 (MD, 0.81 [95% CI, -0.93 to 2.55], P = 0.4) 和血管加压素 (MD, -1.96 [95% CI, -4.59 to 0.66], P=0.1)，但优于无治疗 (MD, 7.99 [95% CI, 6.25-9.72], P<0.01)。

Urea was associated with minor adverse events, with poor palatability being the most common.

尿素与轻微不良事件相关，其中最常见的是口感差。

limitations

As no randomized controlled trials investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies.

由于未发现将尿素作为低钠血症治疗的研究的随机对照试验以供纳入，因此这些分析基于观察性研究。

Conclusions

Urea is safe and effective for managing SIADH-induced hyponatremia.

尿素对于管理由抗利尿激素分泌异常综合征引起的低钠血症是安全且有效的。

These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.

这些发现表明，在资源有限的环境中，或者当其他治疗方法被禁止或耐受性差时，尿素可能是一种有用的治疗方式。

trial_registration

Registered at PROSPERO with study number CRD42024511685.

已在PROSPERO注册，研究编号为CRD42024511685。