Klhůfek Josef, Vodička Martin, Ponížil Petr, Ryšavý Ilja, Fojtík Petr, Kojecký Vladimír, Šálek Tomáš
Department of Clinical Pharmacy, Tomas Bata Hospital Zlin, Zlín, Czech Republic.
Department of Physics and Materials Engineering, Faculty of Technology, Tomas Bata University in Zlín, Zlín, Czech Republic.
J Clin Hypertens (Greenwich). 2025 May;27(5):e70060. doi: 10.1111/jch.70060.
Hyponatremia is a crucial complication of therapy with thiazide diuretics. This study compares the epidemiological and biochemical profiles and hospital course of patients using hydrochlorothiazide (HCTZ), indapamide (INDA), and chlorthalidone (CTD) admitted with thiazide-associated hyponatremia (TAH). Data were obtained retrospectively from the hospital's digital registries. The epidemiological and biochemical parameters between the HCTZ, INDA, and CTD groups were compared. The correlation between dose and biochemical parameters in each group was performed. The thiazide groups without diuretic co-medication were compared (HCTZ vs. INDA), and the correlation between dose and biochemical parameters in each group was examined. A comparison of the HCTZ (n = 135), INDA (n = 125), and CTD (n = 27) groups identified differences in serum potassium (s-K; p = 0.03). The hyponatremia correction rate was slower in the CTD group at 96 h after admission (p < 0.001). After the exclusion of diuretic co-medication, the HCTZ group (n = 64/135) showed a higher prevalence of ARBs, s-K (both p < 0.001), and a lower median (IQR) equipotent dose (12.5 (o) mg vs. 2.5 (1.2) mg), prevalence of ACE-I (p < 0.001), and eGFR (p = 0.03), when compared to the INDA group (n = 109/125). In conclusion, except for s-K, we observed no significant difference in biochemical and epidemiological profiles between HCTZ, INDA, and CTD. After excluding the influence of other diuretics, we observed higher s-K in the HCTZ group compared to the INDA group, potentially explained by the lower equipotent dose of HCTZ. The CTD group showed a statistically significant trend of slower hyponatremia correction.
低钠血症是噻嗪类利尿剂治疗的关键并发症。本研究比较了因噻嗪类相关低钠血症（TAH）入院的使用氢氯噻嗪（HCTZ）、吲达帕胺（INDA）和氯噻酮（CTD）的患者的流行病学和生化特征以及住院病程。数据是从医院的数字登记处回顾性获取的。比较了HCTZ、INDA和CTD组之间的流行病学和生化参数。对每组中剂量与生化参数之间的相关性进行了分析。比较了未联合使用其他利尿剂的噻嗪类药物组（HCTZ与INDA），并检查了每组中剂量与生化参数之间的相关性。对HCTZ组（n = 135）、INDA组（n = 125）和CTD组（n = 27）的比较发现血清钾（s-K）存在差异（p = 0.03）。CTD组在入院后96小时的低钠血症纠正率较慢（p < 0.001）。在排除联合使用其他利尿剂的情况后，与INDA组（n = 109/125）相比，HCTZ组（n = 64/135）的ARB患病率、s-K（均p < 0.001）更高，而等效剂量中位数（IQR）更低（12.5（o）mg对2.5（1.2）mg），ACE-I患病率（p < 0.001）和估算肾小球滤过率（eGFR）（p = 0.03）更低。总之，除了s-K外，我们观察到HCTZ、INDA和CTD在生化和流行病学特征方面没有显著差异。在排除其他利尿剂的影响后，我们观察到HCTZ组的s-K高于INDA组，这可能是由于HCTZ的等效剂量较低所致。CTD组显示出低钠血症纠正较慢的统计学显著趋势。
