Hyponatremia associated with long-term medication use in the elderly: an analysis in general practice
Ignazio Grattagliano 1 , Tecla Mastronuzzi 1 , Gaetano D’Ambrosio 11 Italian College of General Practitioners and Primary Care, Bari, Italy
Correspondence to: Ignazio Grattagliano, Italian College of General Practitioners and Primary Care, Bari 70125, Italy. Email: studiomedico@grattagliano.it
Journal of Primary Health Care 10(2) 167-173 https://doi.org/10.1071/HC17084
Published: 28 June 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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.
KEYWORDS: Arterial hypertension; diabetes; elderly; general practice; hyponatremia
References
[1] Mannesse CK, Vondeling AM, van Marum RJ, et al. Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review. Ageing Res Rev. 2013; 12 165–73.| Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[2] Gross P. Clinical management of SIADH. Ther Adv Endocrinol Metab. 2012; 3 61–73.
| Clinical management of SIADH.Crossref | GoogleScholarGoogle Scholar |
[3] Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: Hyponatremia and hypernatremia. Am Fam Physician. 2015; 91 299–307.
[4] Gankam-Kengne F, Ayers C, Khera A, et al. Mild hyponatremia is associated with an increased risk of death in an ambulatory setting. Kidney Int. 2013; 83 700–6.
| Mild hyponatremia is associated with an increased risk of death in an ambulatory setting.Crossref | GoogleScholarGoogle Scholar |
[5] Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003; 337 169–72.
| Age and gender as risk factors for hyponatremia and hypernatremia.Crossref | GoogleScholarGoogle Scholar |
[6] Crestanello JA, Phillips G, Firstenberg MS, et al. Preoperative hyponatremia predicts outcomes after cardiac surgery. J Surg Res. 2013; 181 60–6.
| Preoperative hyponatremia predicts outcomes after cardiac surgery.Crossref | GoogleScholarGoogle Scholar |
[7] Crestanello JA, Phillips G, Firstenberg MS, et al. Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery? J Thorac Cardiovasc Surg. 2013; 145 1589–94.
| Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery?Crossref | GoogleScholarGoogle Scholar |
[8] Vaishya R, Kaur J, Seema R, et al. Mortality predictions in severe hyponatremia in emergency inpatients. J Indian Med Assoc. 2012; 110 94–7.
[9] Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatremia. Nephrol Dial Transplant. 2014; 29 i1–ii39.
| Clinical practice guideline on diagnosis and treatment of hyponatremia.Crossref | GoogleScholarGoogle Scholar |
[10] Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000; 342 1581–9.
| Hyponatremia.Crossref | GoogleScholarGoogle Scholar |
[11] Soiza RL, Hoyle GE, Chua MPW. Electrolyte and salt disturbances in older people: Causes, management and implications. Rev Clin Gerontol. 2008; 18 143–58.
| Electrolyte and salt disturbances in older people: Causes, management and implications.Crossref | GoogleScholarGoogle Scholar |
[12] Soiza RL, Cumming K, Clarke JM, et al. Hyponatremia: special considerations in older patients. J Clin Med. 2014; 3 944–58.
| Hyponatremia: special considerations in older patients.Crossref | GoogleScholarGoogle Scholar |
[13] Hanotier P. Hyponatremia in the elderly: its role in frailty. Rev Med Brux. 2015; 36 475–84.
[14] Jacob S, Spinler SA. Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Ann Pharmacother. 2006; 40 1618–22.
| Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults.Crossref | GoogleScholarGoogle Scholar |
[15] Viramontes TS, Truong H, Linnebur SA. Antidepressant-induced hyponatremia in older adults. Consult Pharm. 2016; 31 139–50.
| Antidepressant-induced hyponatremia in older adults.Crossref | GoogleScholarGoogle Scholar |
[16] Peyro Saint Paul L, Martin J, Buon M, et al. New frequent adverse reaction of PPI in older adults: mild hyponatremia. Therapie. 2014; 69 157–62.
[17] Bahat G. Risk of proton pump inhibitor-induced mild hyponatremia in older adults. J Am Geriatr Soc. 2014; 62 1206–7.
| Risk of proton pump inhibitor-induced mild hyponatremia in older adults.Crossref | GoogleScholarGoogle Scholar |
[18] Mohan S, Gu S, Parikh A, et al. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med. 2013; 126 1127–37.
| Prevalence of hyponatremia and association with mortality: results from NHANES.Crossref | GoogleScholarGoogle Scholar |
[19] Clayton JA, Rodgers S, Blakey J, et al. Thiazide diuretic prescription and electrolyte abnormalities in primary care. Br J Clin Pharmacol. 2006; 61 87–95.
| Thiazide diuretic prescription and electrolyte abnormalities in primary care.Crossref | GoogleScholarGoogle Scholar |
[20] Ali K, Workicho A, Gudina EK. Hyponatremia in patients hospitalized with heart failure: a condition often overlooked in low-income settings. Int J Gen Med. 2016; 9 267–73.
| Hyponatremia in patients hospitalized with heart failure: a condition often overlooked in low-income settings.Crossref | GoogleScholarGoogle Scholar |
[21] Chawla A, Sterns RH, Nigwekar SU, et al. Mortality and serum sodium: do patients die from or with hyponatremia? Clin J Am Soc Nephrol. 2011; 6 960–5.
| Mortality and serum sodium: do patients die from or with hyponatremia?Crossref | GoogleScholarGoogle Scholar |
[22] Byatt CM, Millard PH, Levin GE. Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions. J R Soc Med. 1990; 83 704–8.
| Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions.Crossref | GoogleScholarGoogle Scholar |
[23] Roe PF. Hyponatraemia and diuretics. Lancet. 1975; 305 1146–7.
| Hyponatraemia and diuretics.Crossref | GoogleScholarGoogle Scholar |
[24] Passare G, Viitanen M, Törring O, et al. Sodium and potassium disturbances in the elderly: prevalence and association with drug use Clin Drug Investig. 2004; 24 535–44.
| Sodium and potassium disturbances in the elderly: prevalence and association with drug useCrossref | GoogleScholarGoogle Scholar |
[25] Odeh M, Schiff E, Oliven A. Hyponatremia during therapy with amiodarone. Arch Intern Med. 1999; 159 2599–600.
| Hyponatremia during therapy with amiodarone.Crossref | GoogleScholarGoogle Scholar |
[26] Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006; 119 S30–S35.
| Incidence and prevalence of hyponatremia.Crossref | GoogleScholarGoogle Scholar |
[27] Balling L, Schou M, Videbæk L, et al. Prevalence and prognostic significance of hyponatraemia in outpatients with chronic heart failure. Eur J Heart Fail. 2011; 13 968–73.
| Prevalence and prognostic significance of hyponatraemia in outpatients with chronic heart failure.Crossref | GoogleScholarGoogle Scholar |
[28] Funk GC, Lindner G, Druml W, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010; 36 304–11.
| Incidence and prognosis of dysnatremias present on ICU admission.Crossref | GoogleScholarGoogle Scholar |
[29] Kovesdy CP, Lott EH, Lu JL, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012; 125 677–84.
| Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure.Crossref | GoogleScholarGoogle Scholar |
[30] Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med. 2009; 122 857–65.
| Mortality after hospitalization with mild, moderate, and severe hyponatremia.Crossref | GoogleScholarGoogle Scholar |
[31] Darmon M, Timsit JF, Francais A, et al. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant. 2010; 25 2510–5.
| Association between hypernatraemia acquired in the ICU and mortality: a cohort study.Crossref | GoogleScholarGoogle Scholar |
[32] Shah MK, Workeneh B, Taffet GE. Hypernatremia in the geriatric population. Clin Interv Aging. 2014; 9 1987–92.
[33] Fitzsimons JT. Angiotensin, thirst, and sodium appetite. Physiol Rev. 1998; 78 583–686.
| Angiotensin, thirst, and sodium appetite.Crossref | GoogleScholarGoogle Scholar |
