Association of serum sodium correction rate with clinical outcomes in adults with hypernatremia: a systematic review and meta-analysis

Background: The optimal rate of serum sodium correction in adults with hypernatremia remains unclear. We evaluated the association of faster vs. slower correction with mortality and other clinical outcomes. Methods: Following the PRISMA 2020 guidelines, we searched seven databases through November 19, 2025, for studies evaluating serum sodium correction rate and clinical outcomes in adults with hypernatremia. For quantitative synthesis, study-defined faster and slower correction categories were retained, with effect directions harmonized as faster versus slower correction. Odds ratios (ORs) and mean differences were pooled using random-effects models, and risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions. Results: Eleven observational studies were included; nine studies (11 comparison units) contributed to the overall mortality meta-analysis. Faster correction was not significantly associated with overall mortality (OR, 0.856; 95% confidence interval [CI], 0.546-1.342), with substantial heterogeneity (I2 = 94.8%) and a wide 95% prediction interval (0.167-4.399). No significant associations were observed for 7-day or 30-day mortality. In exploratory analyses, no significant difference was observed among hypernatremia-onset subgroups, whereas faster correction was associated with higher mortality in intensive care unit (ICU) populations (OR, 1.390; 95% CI, 1.089-1.775; p = 0.008) but not in non-ICU/mixed populations. Neurological complications could not be quantitatively synthesized, and hospital length of stay did not differ significantly. Conclusion: Faster sodium correction was not significantly associated with overall mortality in adults with hypernatremia. However, the observational nature of the available evidence and substantial between-study heterogeneity indicate considerable uncertainty across clinical settings.