Risk of Proton Pump Inhibitor–Induced Mild Hyponatremia in Older Adults

Buon, Marie; Gaillard, Cathy; Martin, J. C.; Fédrizzi, Sophie; Mosquet, Brigitte; Coquerel, Antoine; Paul, Laure Peyro Saint

doi:10.1111/jgs.12534

Cited by 22 publications

(21 citation statements)

References 9 publications

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“…By contrast, no associations were observed with drugs previously reported as causing hyponatremia, such as proton pump inhibitors, oral hypoglycemics, diuretics, inhibitors of the renin-angiotensin system, antipsychotics, and antidepressants [13–18]. To the best of our knowledge, this is the first report to describe an independent association between patterns of drug use dominated by the use of antiplatelet drugs and anticoagulants and lower NaC.…”

Section: Discussionmentioning

confidence: 58%

Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients: A Latent Class Analysis Approach

Woodman

Wood

Kunnel

et al. 2016

Drugs - Real World Outcomes

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BackgroundSeveral drugs may lower serum sodium concentrations (NaC) in older patients. However, distinguishing their individual effects is particularly difficult in this population because of the high prevalence of polypharmacy and disease states that are per se associated with hyponatremia.ObjectivesOur objective was to identify specific patterns of medication use in older hospitalized patients and determine whether these patterns were associated with serum NaC.MethodsWe collected clinical and demographic data, pre-admission drugs, Drug Burden Index (DBI) score, and average NaC during hospitalization in a consecutive series of older medical patients (n = 101, mean ± standard deviation [SD] age 87 ± 6 years). We used latent class analysis (LCA) to identify specific patterns of drug use and multivariate regression to determine the associations between 14 separate drug classes, identified patterns of drug use, and NaC.ResultsLCA revealed three patterns: lower overall drug use (class 1), anticoagulant use and higher drug use (class 2), and antiplatelet use (class 3). Mean (±SD) DBI score in each class was 2.7 ± 1.3, 3.3 ± 1.6, and 2.4 ± 1.5, respectively (p = 0.04). Mean (± SD) NaC in classes 1, 2, and 3 were 140.6 ± 6.8, 138.7 ± 5.3, and 136.5 ± 4.7 mmol/l, respectively (p = 0.006). After adjustment for age, sex, Charlson Comorbidity Index score, estimated glomerular filtration rate (eGFR), DBI score, and digoxin use, mean NaC in class 2 and class 3 was significantly lower than in class 1 (−3.9 mmol/l; 95% confidence interval [CI] −7.1 to −0.8, p = 0.01 and −5.2 mmol/l; 95% CI −7.9 to −2.5, p < 0.001, respectively). Mean serum NaC was not significantly associated with any of the 14 individually assessed drug classes. In addition to latent class, increasing age and higher eGFR were also independently associated with lower serum NaC (p = 0.002 and p = 0.03, respectively).ConclusionLCA enabled us to identify patterns of drug use associated with lower serum NaC in older inpatients. Our results suggest that older patients using antiplatelets or anticoagulants are especially at risk of lower serum NaC.

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Section: Discussionmentioning

confidence: 58%

Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients: A Latent Class Analysis Approach

Woodman

Wood

Kunnel

et al. 2016

Drugs - Real World Outcomes

View full text Add to dashboard Cite

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“…• The consequences of the malabsorption: hyponatremia [17,18], deficiency in vitamin B12 [19] and hypomagnesemia [20,21] (which could have serious consequences such as confusion [22,23])…”

Section: Discussionmentioning

confidence: 99%

Prescription of Proton Pump Inhibitors in Elderly Subjects in Real Life: A Retrospective Study in a Gastroenterology Department

Boudabous¹,

Gdoura²,

Mnif³

et al. 2017

Esophageal Abnormalities

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The proton-pump inhibitor (PPI) is an effective and widely used treatment but may cause side effects, especially for the elderly. Materials and methods: this is a cross-sectional study including 45 patients older than 65 years, followed at our outpatient and treated with PPIs for at least a year. The indication for PPI, the results of any endoscopy, and the quality of the tolerance of these molecules is specified by the data folder. During the consultation, we conducted an interrogation to an update of the history and medications to our patients and a type checking of the molecule, the dose, and the quality of the observance. Results: patients were divided into 32 women and 13 men with a mean age of 75 ± 7 years (65-92). The average length of PPI use was 6 ± 4 years (1-16) with a consumption of a double dose for at least 1 year in 28.8% of cases. The prescribed dose was higher than the recommended dose in at least 15.5% of cases. PPIs were well tolerated. One patient had presented a microscopic colitis, revealed by diarrhea regressed after discontinuation of PPIs. Conclusion: PPIs were prescribed in elderly subjects by gastroenterologists, in a university center, with a high dose and long. In our series, this treatment is well tolerated in the elderly.

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“…The side effects of PPIs are, however, low in prevalence, which itself may be a contributing factor to their over prescription. Reported side effects of PPI therapy include enteric infections such as salmonella and campylobacter [ 7 ], clostridium difficile associated diarrhoea [ 8 ], community acquired pneumonia [ 9 ], hip fractures [ 10 ], B12 deficiency [ 11 ], neuroendocrine tumours of the stomach [ 12 ], drug interactions [ 13 ], interstitial nephritis [ 14 ] and electrolyte disturbances as such as Hypomagnesaemia and hyponatraemia [ 4 ],[ 12 ],[ 15 ],[ 16 ],[ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and outcomes of proton pump inhibitor associated hypomagnesemia in chronic kidney disease

et al. 2018

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BackgroundProton pump inhibitors (PPIs) are one of the most widely prescribed medications across the world. PPIs have been associated with significant electrolyte abnormalities including hypomagnesaemia. We explored the prevalence of PPI associated hypomagnesaemia (PPIH) in different Chronic Kidney Disease (CKD) stages, in different PPI agents, and the impact of PPIH on survival in CKD.MethodsThis was a subgroup analysis of the Salford Kidney Study, a prospective, observational, longitudinal study of non-dialysis CKD patients. Patients with outpatient magnesium samples obtained between 2002 and 2013 were included in the analysis. The prevalence hypomagnesaemia based on mean values over 12 months as well as ‘ever’ hypomagnesaemia were investigated.Results1,230 patients were included in this analysis, mean age 64.3± 32.3 years and mean eGFR 29.2±15.8 ml/min/1.73m2. Mean serum magnesium in those on PPI was significantly lower than those not on PPI overall (0.85±0.10 mmolL-1 versus 0.79±0.12 mmolL-1 respectively, p<0.001). This finding was maintained at all CKD stages. The adjusted odds ratio (OR) for mean hypomagnesaemia in PPI use was 1.12 (95% CI 1.06–1.18) p = <0. ‘Ever hypomagnesaemia’ had an OR of 1.12 (95% CI 1.07–1.16) p = <0.001. The expected rise in serum magnesium with declining eGFR was not observed in those on a PPI but was seen in those not on PPI. There was no difference in serum magnesium between PPI drugs. Thiazide diuretics were also associated with hypomagnesaemia independent of PPI use. Cox regression analysis demonstrated no reduction in survival in patients with PPI associated hypomagnesaemia.ConclusionNo specific PPI drugs show a favourable profile in regards of risk for hypomagnesaemia in CKD. Avoiding concurrent use of PPI and thiazide may be of value in patients with hypomagnesaemia.

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Risk of Proton Pump Inhibitor–Induced Mild Hyponatremia in Older Adults

Cited by 22 publications

References 9 publications

Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients: A Latent Class Analysis Approach

Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients: A Latent Class Analysis Approach

Prescription of Proton Pump Inhibitors in Elderly Subjects in Real Life: A Retrospective Study in a Gastroenterology Department

Prevalence and outcomes of proton pump inhibitor associated hypomagnesemia in chronic kidney disease

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