PP215 - EFFECT OF PROTEIN-RICH NUTRITIONAL THERAPY ON PLASMA SODIUM LEVELS AND CLINICAL OUTCOMES IN MALNOURISHED MEDICAL INPATIENTS WITH HYPONATREMIA: A SECONDARY ANALYSIS OF THE EFFORT TRIAL

PP215

EFFECT OF PROTEIN-RICH NUTRITIONAL THERAPY ON PLASMA SODIUM LEVELS AND CLINICAL OUTCOMES IN MALNOURISHED MEDICAL INPATIENTS WITH HYPONATREMIA: A SECONDARY ANALYSIS OF THE EFFORT TRIAL

M. Lohnke^1,2,*, C. Wunderle¹, P. Tribolet^1,3,4, Z. Stanga⁵, B. Müller^1,2, P. Schütz^1,2

¹Medical University Clinic, Cantonal Hospital Aarau, Aarau, ²Medical Faculty, University of Basel, Basel, ³Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland, ⁴Faculty of Life Sciences , University of Vienna, Vienna, Austria, ⁵Division of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland

Rationale: Chronic hyponatremia is a complex condition associated with falls, neurocognitive impairment, and increased mortality. Protein intake may influence sodium concentration through both dietary and physiological mechanisms. During protein metabolism, urea is produced, which enhances osmotic water excretion. Herein, we studied the effect of nutritional therapy on sodium levels and clinical outcomes among medical inpatients at nutritional risk participating in the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT).

Methods: In this secondary analysis of the randomized controlled EFFORT trial, we investigated the associations between sodium levels on admission and after one week with clinical outcomes and treatment response. The primary outcome was 30-day all-cause mortality.

Results: Among 1’431 patients with available sodium measurements, 28% presented with hyponatremia (serum sodium <135 mmol/L). Persistent hyponatremia, from admission to day 7, was associated with a 73% higher risk for 180-day all-cause mortality compared to patients whose sodium levels normalized by discharge (adjusted HR 1.73 [95% CI 1.03 – 2.89]). Higher protein intake significantly improved sodium normalization during hospitalization: achieving ≥75% and 100% of individual protein targets reduced the risk of day-7 hyponatremia by 27% and 50%, respectively.

Conclusion: We found a strong link between nutritional therapy, sodium levels, and clinical outcomes. Adequate nutritional intake, particularly sufficient protein provision, may promote hyponatremia resolution and thereby improve outcomes in patients. This suggests that targeted nutritional strategies could represent a modifiable approach to improve electrolyte balance and potentially enhance clinical outcomes.

Disclosure of Interest: M. Lohnke: None declared, C. Wunderle Other: CW reports a relationship with Nestlé Health Science, Nutricia Danone, BBraun, Baxter, Abbott Nutrition that includes: lecture fee., P. Tribolet Other: PT reports a relationship with Nestlé Health Science and Abbott Nutrition that includes: lecture fee., Z. Stanga Grant / Research Support from: ZS reports a relationship with Nestlé Health Science, Fresenius Kabi and B. Braun that includes: funding grants. , B. Müller: None declared, P. Schütz Grant / Research Support from: PS reports a relationship with Roche, Thermo Fisher, bioMérieux, Nestlé Health Science and Abbott Nutrition that includes: funding grants.