Hyponatremia associated with long-term medication use in the elderly: an analysis in general practice

Abstract

INTRODUCTION The aim of this study is to determine the prevalence of hyponatremia, its association with long-term medication use and underlying chronic conditions, the rate of hospitalisation and death within 3 months from its discovery and its management in community-dwelling older people. METHODS One year of data for ~5635 patients aged >65 years was extracted from the databases of 19 general practitioners (GPs); 2569 (45.6%) were checked for hyponatremia. RESULTS Hyponatremia occurred in 205 (8.0%) of 2569 checked individuals: 78.5% (161/205) had hypertension, 31.2% (64/205) diabetes, 23.9% (49/205) chronic renal failure; 38.0% (78/205) received diuretics, 36.6% (75/205) renin-angiotensin system antagonists (ACE-I/ARB) and 9.8% (20/205) serotonin reuptake inhibitors. Drug consumption was higher in hyponatremic patients, although only diuretics, ACE-I/ARB, anti-arrhythmics and opioids were significantly associated with hyponatremia. The likelihood of hyponatremia trebled when four drugs were taken, and it was seven-fold higher with the use of six drugs. Hyponatremia was associated with a higher prevalence of chronic illnesses and higher rate of hospitalisation (13.7% vs 7.7%, P = 0.005) and death (3.9% vs 1.8%, P < 0.035). The use of at least one long-term medication was associated with hospitalisation or death in hyponatremic patients (10% vs 6.3%, P = 0.010). Less than 20% of hyponatremic patients had their sodium level checked again after 1 month. DISCUSSION Hyponatremia is not uncommon among community-living older patients, especially in patients taking medications potentially causing hyponatremia. Hyponatremic patients are likely to encounter more serious events, including hospitalisation and death. Targeted training of GPs is desirable to improve their practice.

Increased Mortality in Elderly Patients Admitted with Hyponatremia: A Prospective Cohort Study

“…Our sample had more comorbidities compared to the literature [ 19 , 31 ], as was anticipated since we only included older patients. A very high proportion of patients in our study were using angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, thiazide diuretics and furosemide, which is in line with other studies in the literature, which show that these drugs predispose patients to hyponatremia [ 35 , 36 ]; however, for some drugs, such as furosemide, this association may not reflect a causal role with hyponatremia but a causal role between the indication for which the medication is prescribed (more typically heart failure) and hyponatremia.…”

Prevalence of hyponatremia among older inpatients in a general hospital

“…Previous studies on older patients have reported a prevalence of chronic hyponatremia of 8% among those living in private homes [ 19 ]. Tay et al measured the electrolytes of 5873 outpatients (age ≥ 60 years) and found that 403 (6.9%) had hyponatremia in at least one blood test [ 20 ].…”

“…Concomitant administration of drugs that affect water homeostasis, such as SSRIs, SNRIs, NSAIDs, or benzodiazepines, is frequent in older patients with thiazide-associated hyponatremia [ 5 ]. In a retrospective study of 2569 patients (aged > 65 years) in community-dwelling older people, Grattagliano et al reported the likelihood of hyponatremia trebled when four drugs were taken, and it was seven-fold higher with the use of six drugs [ 19 ]. As mentioned earlier, our study identified PPIs, loop diuretics, potassium sparing diuretics, ACEIs/ARBs, thiazide diuretics and NSAIDs as drugs frequently associated with hyponatremia in patients.…”

Effects of Natural Reduced Water on Cognitive Function, Body Composition, and Psychological Function in Older Adults: Study Protocol for a Randomized Controlled Trial

“…Based on previous studies [13][14][15][16], the exclusion criteria for the participants included conditions related to electrolyte abnormalities (such as hyponatremia). The criteria were as follows:…”