Prognostic and predictive role of hyponatremia in cancer patients

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.