title: Evaluations of hospitalizations associated with thiazide-associated hyponatremia.
abstract: The prevalence of hypertension in the United States has grown dramatically in recent years. Thiazide diuretics have played a major role in the rising rate of blood pressure (BP) control. Accompanying this has been the appearance of adverse drug events, including hospitalizations associated with thiazide-associated hyponatremia (HTAH). Hyponatremia is a common yet often overlooked side effect of this drug class. Identification of HTAH risk factors may aid in creating strategies to prevent hospitalizations. This is a retrospective, case-controlled study of 10,805 patients (1802 cases, 9003 controls) examining HTAH risk factors within a group-model integrated-care organization. Multivariate analysis revealed that age (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.58-1.93), angiotensin-converting enzyme (ACE) inhibitor use (OR, 1.53; 95% CI, 1.16-2.00), and hypokalemia (OR, 40.94; 95% CI, 26.46-66.33) were most associated with HTAH. Urinary tract infection (UTI), type 2 diabetes, hyperlipidemia, and gastroesophageal reflux disease (GERD) were also found to be HTAH risk factors. Potassium supplements (OR, 0.60; 95% CI, 0.44-0.83) and weight (OR, 0.91; 95% CI, 0.88-0.93) had protective effects. A predictive model was developed to determine overall HTAH risk given the presence of individual risk factors. Age, weight, hypokalemia, GERD, type 2 diabetes, UTI, and ACE inhibitor use independently correlated with an increased risk of HTAH. This model may be applied in clinical practice to guide thiazide prescribing.
authors.affiliation: Kaiser Permanente Woodland Hills Medical Center, 5601 De Soto Ave., Woodland Hills, CA, USA. divaker.x.rastogi@kp.org
authors.forename: Divaker
authors.initials: D
authors.lastname: Rastogi
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Pelter
authors.forename: Robert L
authors.initials: RL
authors.lastname: Deamer
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors