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Peri. J Cancer Metastasis Treat 2019;5:40 Journal of Cancer
DOI: 10.20517/2394-4722.2019.14 Metastasis and Treatment

Review Open Access

Prognostic and predictive role of hyponatremia in
cancer patients

Alessandro Peri

Sodium Unit, Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence,
Careggi Hospital, Florence 50139, Italy.

Correspondence to: Prof. Alessandro Peri, Sodium Unit, Endocrinology, Department of Experimental and Clinical Biomedical
Sciences “Mario Serio”, University of Florence, Careggi Hospital, AOU Careggi, Viale Pieraccini 6, Florence 50139, Italy.
E-mail: alessandro.peri@unifi.it
How to cite this article: Peri A. Prognostic and predictive role of hyponatremia in cancer patients. J Cancer Metastasis Treat
2019;5:40. http://dx.doi.org/10.20517/2394-4722.2019.14
Received: 5 Feb 2019 First Decision: 25 Feb 2019 Revised: 4 Mar 2019 Accepted: 11 Mar 2019 Published: 6 May 2019

Science Editor: Berardi Rossana Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
Hyponatremia is the most frequent electrolyte disorder encountered in hospitalized patients. Several studies have
demonstrated that hyponatremia is a negative prognostic factor in different clinical scenarios. Noteworthy, not
only severe and acute hyponatremia has been associated with an increased risk of mortality, but also moderate of
even mild chronic hyponatremia may increase the risk of death. This has been demonstrated in different categories
of patients, including cancer patients. There is growing evidence that both progression free survival and overall
survival are significantly reduced in cancer patients with hyponatremia compared to patients with normonatremia.
One important, and still open, question is whether the worse outcome associated with hyponatremia in cancer
patients is directly attributable to the electrolyte disorder itself or might be a sign of the severity of the underlying
disease. With regard to this point, some basic research studies suggested that low sodium concentration
stimulates per se cancer cells proliferation and invasiveness. Recent clinical evidence appears to indicate that the
correction of hyponatremia is an independent and favourable prognostic factor in cancer patients. Admittedly,
robust confirmatory data from clinical practice are needed, in order to validate the hypothesis that cancer patients
may die for hyponatremia and not just with hyponatremia.

Keywords: Hyponatremia, cancer, mortality, prognosis, vasopressin

INTRODUCTION
[1]
Hyponatremia, which is the most frequent electrolyte disorder in hospitalized patients , frequently occurs
also in cancer patients at different stages of disease. For instance, a recent retrospective study, performed
© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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