SIADH
Conditions
Keywords
Hyponatremia, SGLT2 inhibitor
Brief summary
Syndrome of inappropriate antidiuresis (SIADH) is characterized by an imbalance of antidiuretic vasopressin (AVP) secretion. The impaired AVP regulation leads to water retention and secondary natriuresis and is a common cause for hyponatremia. The therapeutic options, aside from treating the underlying disease, depend upon the onset and severity of the symptoms and involve usually fluid restriction or hypertonic saline infusion. Alternative therapeutic options are loop diuretics, administration of oral urea or vasopressin receptor antagonists (vaptans). Despite those options, there are a considerable number of patients which do not sufficiently respond, making additional therapy necessary. Empagliflozin (Jardiance)® is a sodium glucose co-transporter 2 (SGLT2)-inhibitor, which is a new treatment option developed for patients with diabetes mellitus type 2. The SGLT2 is expressed in the proximal tubule and reabsorbs approximately 90 percent of the filtered glucose. The inhibition of SGLT2 results in renal excretion of glucose with subsequent osmotic diuresis. This mechanism could result in a therapeutic effect in patients with hypotonic hyponatremia as in SIADH. The aim of this study is to evaluate whether empagliflozin (Jardiance)® has an effect on the serum sodium levels of patients with SIADH.
Interventions
DRUGEmpagliflozin
OTHERPlacebo
Sponsors
University Hospital, Basel, Switzerland
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 84 Years
Healthy volunteers
No
Inclusion criteria
\- Hyponatremia \<130mmol/l due to SIADH
Exclusion criteria
* any Treatment for SIADH during \>48h before study start * severe illness with ICU-Admission * Treatment with 3% sodium Chloride (NaCl) solution * uncontrolled hypothyroidism * uncontrolled adrenal insufficiency * severe renal impairment (GFR \<30ml/min), end stage renal disease * severe hepatic impairment (Child-Pugh class C) * systolic blood pressure \<90mmHg * Diabetes mellitus type 1 * acute myocardial infarction or chronic venous insufficiency (CVI) * Treatment with SGLT2 Inhibitor, Lithium Chloride or Urea * recurrent urinary-/genital tract infections * contraindication for lowering blood pressure * severe immunosuppression * pregnancy or breastfeeding * palliative care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Serum sodium | 4 days | The primary outcome is the change in serum sodium concentration from baseline to day 5, i.e. 4 days after start of treatment with study drug |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fluid intake | 4 days | amount of daily fluid intake |
| Urinary excretion | 4 days | amount of daily urinary excretion |
| Serum electrolytes | 4 days | change of serum electrolytes from baseline to day 5 |
| Urinary electrolytes | 4 days | Change of Serum electrolytes from baseline to day 5 |
| Serum osmolality | 4 days | Change of Serum osmolality from baseline to day 5 |
| Urine osmolality | 4 days | Change of urinary osmolality from baseline to day 5 |
| Serum glucose | 4 days | Change of Serum glucose from baseline to day 5 |
| Urinary glucose | 4 days | Change of urinary Glucose from baseline to day 5 |
| Copeptin | 4 days | Change of Copeptin from baseline to day 5 |
| Aldosterone | 4 days | Change of Aldosterone from baseline to day 5 |
| Renin | 4 days | Change of Renin from baseline to day 5 |
| Serum sodium | 1 day | Serum sodium concentration 1 day after start of Treatment with study drug |
| Brain-Natriuretic-Peptide (BNP) | 4 days | Change of BNP from baseline to day 5 |
| General well-being | 4 days | course of General well-being from baseline to day 5 as assessed by patient's self-rating score |
| Symptoms of hyponatremia | 4 days | course of hyponatremia symptoms from baseline to day 5 |
| Body weight | 4 days | Change of Body weight from baseline to day 5 |
| Blood pressure | 4 days | Change of blood pressure from baseline to day 5 |
| Heart rate | 4 days | Change of heart rate from baseline to day 5 |
| length of hospital stay | 30 days | length of hospital stay |
| Treatment escalation | 30 days | rate of Need for Treatment escalation |
| ICU Admission rate | 30 days | rate of Admission to ICU |
| Recurrence hyponatremia | 30 days | recurrence rate hyponatremia |
| Hospital readmission rate | 30 days | rate of readmission |
| atrial natriuretic peptide (ANP) | 4 days | Change of ANP from baseline to day 5 |
Countries
Switzerland
Outcome results
None listed