低钠血症老年患者对低钠血症诱导药物的认识：一项关于其普遍使用及其与复发性症状性或严重低钠血症关联的研究。

Awareness of the use of hyponatraemia-inducing medications in older adults with hyponatraemia: a study of their prevalent use and association with recurrent symptomatic or severe hyponatraemia.

机构信息

College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.

Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea.

出版信息

Age Ageing. 2021 Jun 28;50(4):1137-1143. doi: 10.1093/ageing/afaa195.

DOI:10.1093/ageing/afaa195

PMID:32946587

Abstract

BACKGROUND

Cautious use or avoidance of hyponatraemia-inducing medications (HIMs) is recommended in older patients with hyponatraemia.

OBJECTIVE

To evaluate the use of HIMs after treatment for symptomatic or severe hyponatraemia and to investigate the impact of HIMs on the recurrence of symptomatic or severe hyponatraemia in older patients.

DESIGN AND SETTINGS

A cross-sectional and nested case-control study using data obtained from national insurance claims databases.

METHODS

The rate of prescribing HIMs during the 3 months before and after the established index date was analysed in a cross-sectional analysis. Multivariable logistic regression was performed to investigate the association between HIM use and recurrence of symptomatic or severe hyponatraemia after adjusting for covariates in a case-control study.

RESULTS

The cross-sectional study included 1,072 patients treated for symptomatic or severe hyponatraemia. The proportion of patients prescribed any HIMs after hyponatraemia treatment decreased from 76.9 to 70.1%. The prescription rates significantly decreased for thiazide diuretics (from 41.9 to 20.8%) and desmopressin (from 8.6 to 4.0%), but the proportion of patients prescribed antipsychotics increased from 9.2 to 17.1%. Of 32,717 patients diagnosed with hyponatraemia, 913 (2.8%) showed recurrent hyponatraemia. After adjusting for comorbid conditions, the use of any HIMs including proton pump inhibitors [adjusted odds ratio (aOR) 1.34, 95% confidence interval (CI) 1.15-1.57] and two or more HIMs (aOR 1.48, 95% CI 1.22-1.78) especially in combination with thiazide diuretics increased the likelihood of severe hyponatraemia recurrence.

CONCLUSIONS

Prevalent use of HIMs after treatment for symptomatic or severe hyponatraemia and multiple HIM use increase the risk of recurrent hyponatraemia in geriatric patients.

摘要

背景

对于伴有低钠血症的老年患者，建议谨慎使用或避免使用可引起低钠血症的药物（HIMs）。

目的

评估在治疗有症状或严重低钠血症后 HIMs 的使用情况，并研究 HIMs 对老年患者有症状或严重低钠血症复发的影响。

设计和设置

使用来自国家保险索赔数据库的数据进行横断面和嵌套病例对照研究。

方法

在横断面分析中分析了在既定指数日期前后 3 个月内处方 HIMs 的比率。在病例对照研究中，通过多变量逻辑回归调整协变量后，研究 HIM 使用与有症状或严重低钠血症复发之间的关联。

结果

横断面研究纳入了 1072 例治疗有症状或严重低钠血症的患者。低钠血症治疗后处方 HIMs 的患者比例从 76.9%降至 70.1%。噻嗪类利尿剂（从 41.9%降至 20.8%）和去氨加压素（从 8.6%降至 4.0%）的处方率显著下降，但抗精神病药物的处方比例从 9.2%增至 17.1%。在诊断为低钠血症的 32717 例患者中，有 913 例（2.8%）出现低钠血症复发。调整合并症后，包括质子泵抑制剂在内的任何 HIMs 的使用（调整后的优势比[aOR]1.34，95%置信区间[CI]1.15-1.57）和使用两种或更多 HIMs（aOR 1.48，95%CI 1.22-1.78），尤其是与噻嗪类利尿剂联合使用，增加了严重低钠血症复发的可能性。