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Non‐thiazide diuretics and hospitalization due to hyponatraemia: A population‐based case‐control study
Author(s) -
Mannheimer Buster,
Falhammar Henrik,
Calissendorff Jan,
Lindh Jonatan D,
Skov Jakob
Publication year - 2021
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14497
Subject(s) - spironolactone , thiazide , furosemide , medicine , hypokalemia , amiloride , diuretic , odds ratio , population , confounding , endocrinology , aldosterone , sodium , chemistry , environmental health , organic chemistry
Objective Diuretics are often implicated in hyponatraemia. While thiazides constitute one of the most common causes of hyponatraemia, data on loop diuretics and potassium‐sparing agents are limited and partly conflicting. The objective of this investigation was to study the association between use of different types of non‐thiazide diuretics and hospitalization due to hyponatraemia. Design, Patients and Measurements This was a register‐based case‐control study on the adult Swedish population. By linking national registers, patients hospitalized with a principal diagnosis of hyponatraemia (n = 11,213) from 1 October 2005 through 31 December 2014 were compared with matched controls (n = 44,801). Multivariable logistic regression, adjusted for multiple confounders, was used to analyse the association between use of diuretics and hyponatraemia. In addition, newly initiated use (≤90 days) and ongoing use were examined separately. Results Adjusted odds ratios (aORs) (95% CI) were 0.61 (0.57–0.66) for the use of furosemide, 1.69 (1.54–1.86) for the use of amiloride and 1.96 (1.78–2.18) for the use of spironolactone and hospitalization due to hyponatraemia. For newly initiated therapy, aORs ranged from 1.23 (1.04–1.47) for furosemide to 3.55 (2.75–4.61) for spironolactone. The aORs for ongoing use were 0.52 (0.47–0.57) for furosemide, 1.62 (1.47–1.79) for amiloride and 1.75 (1.56–1.98) for spironolactone. Conclusions Ongoing use of furosemide was inversely correlated with hospitalization due to hyponatraemia, suggesting a protective effect. Consequently, if treatment with furosemide precedes the development of hyponatraemia by some time, other causes of hyponatraemia should be sought. Spironolactone and amiloride may both contribute to hyponatraemia; this effect is most prominent early in treatment.