THU112 Effect Of Protein Supplementation On Plasma Sodium Levels And Urinary Urea Excretion In Patients With Chronic Siad—A Monocentric Open-Label Proof-Of-Concept Study—The Treasure Study
Authors: Monnerat Sophie , Atila Cihan , Baur Fabienne Elisabeth , Dickenmann Michael , Christ-Crain Mirjam 
Published: October 2023

Abstract
Disclosure: S. Monnerat: None. C. Atila: None. F.E. Baur: None. M. Dickenmann: None. M. Christ-Crain: None.
INTRODUCTION The syndrome of inappropriate antidiuresis (SIAD) is the most common cause of euvolemic hyponatremia. Besides fluid restriction, increasing free-water clearance is an effective treatment approach that can be achieved through osmotic diuresis by administering oral urea. However, oral urea has a very peculiar taste that impedes long-term compliance. Dietary proteins are metabolized into soluble excretable urea by the liver. We hypothesized that dietary protein could increase free water clearance through urea-induced osmotic diuresis and therefore aimed to investigate the effect of high-protein supplementation on plasma sodium levels in outpatients with chronic SIAD. METHODS This is an interim analysis of a monocentric open-label proof-of-concept trial conducted at the University Hospital of Basel since October 2021. Adult outpatients with chronic SIAD of any etiology were eligible. Patients received 90g protein daily for 7 days in the form of protein powder dissolved in a maximum of 1L of liquid of choice. After a wash-out period of at least a week, patients received 30g of oral urea daily for 7 days. Patients were asked to keep their baseline fluid intake unchanged throughout the study. The primary endpoint was the increase in sodium levels from baseline to the end of the 7-day protein supplementation. RESULTS Thirteen patients, 10 females and 3 males, with chronic SIAD were included. Median [IQR] age was 63 [61, 80] and the median [IQR] duration of hyponatremia was 33 months [12, 42]. At baseline, median [IQR] plasma sodium concentration was 130 mmol/L [129, 133]. Eight patients had mild hyponatremia (130-134 mmol/L), 4 had moderate hyponatremia (125-129 mmol/L), and 1 patient had profound hyponatremia (&lt;125 mmol/L). After 7 days of 90g daily protein supplementation (n = 13), sodium levels increased by a median [IQR] of 3 mmol/L [0, 5], blood urea nitrogen increased by a median [IQR] of 4.3 mmol/L [1.7, 5.1] and urinary urea corrected for urine creatinine increased by a median [IQR] of 26.0 mmol/mmol [17.1, 32.3]. After 7 days of oral urea (n = 8), sodium levels increased by a median [IQR] of 2 mmol/L [1, 3], blood urea nitrogen increased by a median [IQR] of 8.5 mmol/L [3.8, 10.2] and urinary urea corrected for urine creatinine increased by a median [IQR] of 31 mmol/mmol [21.1, 39.8]. CONCLUSION This interim analysis suggests that high-protein supplementation with protein powder increases plasma sodium levels in patients with chronic SIAD. The increase in urea concentration in both plasma and urine upon protein supplementation is comparable to the increase upon oral urea administration, which supports protein-induced ureagenesis to be the underlying mechanism of action.
Presentation: Thursday, June 15, 2023