title: Preadmission Diuretic Use and Mortality in Patients Hospitalized With Hyponatremia: A Propensity Score-Matched Cohort Study.
abstract: BACKGROUND
  Hyponatremia is associated with increased mortality and is frequently induced by diuretic use. It is uncertain whether diuretic use is linked to mortality risk in patients with hyponatremia.
  
  
  OBJECTIVE
  To measure the prognostic impact of diuretic use on 30-day mortality among patients hospitalized with hyponatremia.
  
  
  METHODS
  Using population-based registries, we identified all patients with a serum sodium measurement <135 mmol/L within 24 hours after acute hospital admission in western Denmark from 2006 to 2012 (cumulative population of 2.2 million). We categorized patients as current diuretic users (new and long-term), former users or nonusers, and followed them until death, migration or up to 30 days which ever came first.
  
  
  METHODS
  Thirty-day cumulative mortality and relative risk with 95% confidence interval (CI) controlled for demographics, previous morbidity, renal function, and co-medications. Calculations were also divided by the diuretic type and were repeated after propensity score matching.
  
  
  RESULTS
  Thirty-day mortality was 11.4% among current diuretic users (n = 14,635) compared with 6.2% among nonusers, yielding an adjusted relative risk of 1.4 (95% CI, 1.2-1.5). New users were at higher risk (1.7, 95% CI, 1.5-2.0) than long-term users (1.3, 95% CI, 1.2-1.4). In particular, the use of loop diuretics (1.6, 95% CI, 1.4-1.8), potassium-sparing diuretics (1.6, 95% CI, 1.2-2.2), and diuretic polytherapy (1.5, 95% CI, 1.3-1.7) were associated with increased risk, whereas thiazide use was not (1.0, 95% CI, 0.9-1.2). Propensity score-matched analyses confirmed the results.
  
  
  CONCLUSIONS
  Diuretic use except from thiazides, and particularly if newly initiated, is a negative prognostic factor in patients admitted with hyponatremia.
authors.affiliation: Departments of Clinical Epidemiology and.|Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Holland-Bill
authors.affiliation: Departments of Clinical Epidemiology and.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Christiansen
authors.affiliation: Departments of Clinical Epidemiology and.
authors.forename: Sinna P
authors.initials: SP
authors.lastname: Ulrichsen
authors.affiliation: Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Troels
authors.initials: T
authors.lastname: Ring
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jens O
authors.initials: JO
authors.lastname: Lunde Jørgensen
authors.affiliation: Departments of Clinical Epidemiology and.
authors.forename: Henrik T
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D055815:Young Adult
chemical_list: D004232:Diuretics; D012964:Sodium