Masao Toyoda, Naoki Sakane, Akiko Suganuma, Masahito Ogura, Junnosuke Miura, Daisuke Tsuriya, Akinori Hayashi, Hideaki Sawaki, Shota Suzuki, Tatsuhiko Urakami, Yushi Hirota, Arata Itoh, Shu Meguro, Kenji Kamiuchi, Tomokazu Matsuda, Hitomi Nakayama, Yoshihiko Yuyama, Tomoyuki Kawamura, Atsuhito Tone, Ken Kato, Akira Kuroe, Akio Kuroda, Munehide Matsuhisa, Akira Shimada, Takashi Murata, The REALJ Study Group
Recommendation from the Editor
Arginine vasopressin deficiency (AVP-D) is an important cause of polyuria-polydipsia syndrome. Although highly informative, the hypertonic saline test (HST) places a considerable burden on patients. In this issue, Dr Satoshi Naito at Nagoya University and his colleagues developed an interpretable prediction model based on four laboratory variables obtained before the HST: urinary osmolality, serum sodium, plasma AVP, and blood urea nitrogen. In a cohort of 64 patients, the logistic regression model achieved an area under the receiver operating characteristic curve of 0.862 for predicting impaired AVP secretion during the HST. At an optimized rule-in threshold, the model achieved a positive predictive value of 100% (14/14) in the subgroup of 35 patients evaluated for suspected AVP-D, suggesting that the HST might be deferred in approximately 40% of these patients. Our editorial team particularly recommends this article because it presents a promising and patient-centered approach to streamlining the diagnostic evaluation of AVP-D.