Incidence of hospital-acquired hyponatremia by the dose and type of diuretics among patients with acute heart failure and its association with long-term outcomes

• Published in: Journal of cardiology 2018-06, Vol.71 (6), p.550-556
• Main Authors: Yamazoe, Masahiro, Mizuno, Atsushi, Kohsaka, Shun, Shiraishi, Yasuyuki, Kohno, Takashi, Goda, Ayumi, Higuchi, Satoshi, Yagawa, Mayuko, Nagatomo, Yuji, Yoshikawa, Tsutomu
• Format: Article
• Language: English
• Subjects: Heart failure; Hyponatremia; Loop diuretics; Thiazide diuretics
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2017.09.015

•Thiazide diuretics were independently associated with hospital-acquired hyponatremia.•Mortality rate was higher in the thiazide users even after statistical matching.•Thiazide diuretic use in acute decompensation of heart failure may be a modifiable risk factor for adverse outcomes. Diuretics are the cornerstone therapy for acute heart failure (AHF) but can lead to various electrolyte disturbances and inversely affect the patients’ outcome. We aimed to evaluate whether (1) the dose of loop diuretics could predict hospital-acquired hyponatremia (HAH) during AHF treatment, (2) addition of thiazide diuretics could affect development of HAH, and (3) assess their impact on long-term outcomes. We analyzed the subjects enrolled in the multicenter AHF registry (WET-HF). Risk of HAH, defined as hyponatremia at discharge with normonatremia upon admission, was evaluated based on oral non-potassium-sparing diuretics via multivariate logistic regression analysis. Additionally, we performed one-to-one matched analysis based on propensity scores for thiazide diuretics use and compared long-term mortality. Of total 1163 patients (mean age 72.6±13.6 years, male 62.6%), 92 (7.9%) had HAH. Compared with low-dose loop diuretics users (