Risk factors for thiazide-induced hyponatraemia.
BACKGROUND
Thiazide-induced hyponatraemia is common and potentially life threatening. In the absence of well-defined risk factors for this complication, guidelines for prescribing cannot be established.


OBJECTIVE
To examine whether a subgroup of patients is particularly susceptible to this complication.


METHODS
Retrospective case-control study.


METHODS
We defined and recruited cases of symptomatic hyponatraemia that necessitated hospitalization from January 1996 to April 2002. Controls were selected from 8420 patients being prescribed thiazides and seen at the same institution during that period of time.


RESULTS
There were 223 cases and 216 controls, with a median 115 days thiazide use. Cases were older than controls (76 +/- 9 vs. 66 +/- 13 years, p < 0.001) and lighter (52.3 +/- 10.3 vs. 63.4 +/- 3 kg, p < 0.001). By univariate analysis, serum potassium level, use of indapamide, elderly home institutionalization and physical immobility were risk factors for thiazide-induced hyponatraemia, but gender, duration of thiazide use, concomitant therapy with loop diuretics, angiotensin-converting enzyme inhibitors or non-steroidal anti-inflammatory drugs, and renal function were not. By stepwise logistic regression analysis, patient age, body weight and serum potassium were the only independent predictive factors. Each 10-year increment of age was associated with a two-fold increase in risk (hazards ratio 2.14, 95%CI 1.59-2.88). For a 5 kg increment in mass, there was a 27% decrease in odds ratio (odds ratio 0.77, 95%CI 0.68-0.87). One SD increase in serum potassium (0.84 mmol/l) was associated with a 63% decrease in risk (odds ratio 0.37, 95%CI 0.27-0.50; p < 0.0001).


CONCLUSIONS
Hyponatraemia is a common problem after thiazide therapy. Extra caution and close monitoring are warranted when prescribing thiazides for elderly patients with low body mass.
Chow
K M
KM
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Szeto
C C
CC
Wong
T Y-H
TY
Leung
C B
CB
Li
P K-T
PK
D000368:Aged; D001581:Benzothiadiazines; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D016022:Case-Control Studies; D004232:Diuretics; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects*
D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors