Korean Journal of Nephrology 2011;30(5):468-474.
Clinical Features of Hyponatremia: Changes Related to Increasing Use of Thiazide-Combination Diuretics
In Hye Cha, M.D., Eun Jung Cho, M.D., Ki Chul Yoon, M.D., Hye Jin Noh, M.D., Hye Min Choi, M.D., Jae-Won Lee, M.D., Sang-Kyung Jo, M.D., Hyoung Kyu Kim, M.D. and Won Yong Cho, M.D.
Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
원저 : 입원 환자에서 발생한 저나트륨혈증: Thiazide 병합 이뇨제 사용 증가와 관련한 저나트륨혈증의 임상양상
차인혜, 조은정, 윤기철, 노혜진, 최혜민, 이재원, 조상경, 김형규, 조원용
고려대학교 의과대학 내과학교실 신장내과
Abstract
Purpose: In this study, the etiology and the change of clinical characteristics of hyponatremia, in relation to the increased used of thiazide diuretics, have been assessed. Methods: To perform a retrospective cohort study, a total sum of 322 patients who have been admitted in a single tertiary referral hospital between 2004 and 2009, were included. Results: The most common cause of hyponatremia was due to thiazide diuretics (37.6%). Among the 121 patients who suffered from thiazide induced hyponatremia, 60 (48.0%) patients took combination thiazide. The incidence of hyponatremia has shown a tendency to increase from 2004 to 2009 (trend test, p<0.001). The incidence of hyponatremia due to the use of combination types has also increased (trend test, p<0.001). Thiazide induced hyponatremia showed no difference when compared to hyponatremia due the other causes, except the fact that the portion of female patients was higher (73.6% vs 64.6%, p<0.001), mean age was older (74.7 vs 69.9 years-old, p<0.001), and incidence of cerebrovascular accident was also higher (19.8% vs 6.5%, p<0.001). Conclusion: The use of thiazide is increasing and hence thiazide-induced hyponatremia is also increasing. This is thought to be particularly related to the increase of thiazide-combined drugs. Thiazideinduced hyponatremia shows a higher incidence in old age, female sex and those who have a history of a cerebrovascular event. Hence more caution is needed when using thiazide diuretics as antihypertensives, and plasma sodium levels should be monitored carefully.
Key Words: Hyponatremia, Incidence, Diuretics
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