10/02/2026
🎉 มาแล้ว กับงานวิจัยชิ้นแรกของปี 2569 จาก NephroTU
📄 New RCT in Kidney Medicine (2026): The EFFLUX-FLUID Trial
Fluid restriction is still considered first-line therapy for SIAD, but many patients—especially those with profound hyponatremia—simply don’t respond. The EFFLUX-FLUID trial asked an important clinical question:
👉 Can low-dose tolvaptan outperform the commonly used combination of fluid restriction, furosemide, and salt tablets in patients at high risk of fluid restriction failure?
🔬 Study design
Single-center, open-label randomized controlled trial in hospitalized adults with chronic SIAD and serum sodium ≤125 mmol/L, all with predictors of fluid restriction failure. Patients were randomized to:
1. Low-dose tolvaptan 7.5 mg/day with liberal fluid intake, or
2. Fluid restriction (800 mL/day) + furosemide + NaCl tablets
📊 Key findings
- Tolvaptan increased serum sodium more rapidly and to a greater extent by day 4 (+12.2 vs +6.3 mmol/L)
- More patients reached Na ≥130 mmol/L by day 4 (77% vs 25%)
- Median time to correction was significantly shorter (2 vs 14 days)
- Hypokalemia was less frequent with tolvaptan
- Overcorrection occurred in 23% of tolvaptan patients, but no osmotic demyelination syndrome was observed under close monitoring
🧠 Clinical take-home message
In SIAD patients with profound hyponatremia and predictors of fluid restriction failure, low-dose tolvaptan is an effective and faster second-line option compared with the traditional combination strategy. However, careful sodium monitoring remains essential, even at low doses.
https://linkinghub.elsevier.com/retrieve/pii/S2590059525002754
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