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

Masahiro Yamazoe, Atsushi Mizuno, Shun Kosaka, Yasuyuki Shiraishi, Takashi Kohno, Ayumi Goda, Satoshi Higuchi, Mayuko Yagawa, Yuji Nagatomo, Tsutomu Yoshikawa

研究成果: Article

2 引用 (Scopus)

抄録

Background: 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. Methods: 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. Results: 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 (<40. mg; without thiazide diuretics), risks for developing HAH were significantly higher in patients with thiazide diuretics, regardless of the dose of loop diuretics (OR 2.67, 95% CI 1.13-6.34 and OR 2.31, 95% CI 1.50-5.13 for low- and high-dose loop diuretics, respectively). The association was less apparent in patients without thiazide diuretics (OR 1.29, 95% CI 0.73-2.27 for high-dose loop diuretics alone). Among 206 matched patients, all-cause and cardiac mortality rate was 27% and 14% in non thiazide diuretics users and 50% and 30% in thiazide diuretics users, respectively (HR 2.46, 95% CI 1.29-4.69, p = 0.006 and HR 2.50, 95% CI 1.10-5.67, p = 0.028, respectively) during a mean 19.3 months of follow-up. Conclusions: Thiazide diuretics use, rather than loop diuretics dose, was independently associated with HAH; and mortality was higher in thiazide diuretics users even after statistical matching.

元の言語English
ジャーナルJournal of Cardiology
DOI
出版物ステータスAccepted/In press - 2018 1 1

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Sodium Chloride Symporter Inhibitors
Hyponatremia
Diuretics
Sodium Potassium Chloride Symporter Inhibitors
Heart Failure
Incidence
Mortality
Propensity Score
Electrolytes
Registries
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

これを引用

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. / Yamazoe, Masahiro; Mizuno, Atsushi; Kosaka, Shun; Shiraishi, Yasuyuki; Kohno, Takashi; Goda, Ayumi; Higuchi, Satoshi; Yagawa, Mayuko; Nagatomo, Yuji; Yoshikawa, Tsutomu.

:: Journal of Cardiology, 01.01.2018.

研究成果: Article

Yamazoe, Masahiro ; Mizuno, Atsushi ; Kosaka, Shun ; Shiraishi, Yasuyuki ; Kohno, Takashi ; Goda, Ayumi ; Higuchi, Satoshi ; Yagawa, Mayuko ; Nagatomo, Yuji ; Yoshikawa, Tsutomu. / 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. :: Journal of Cardiology. 2018.
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abstract = "Background: 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. Methods: 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. Results: 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 (<40. mg; without thiazide diuretics), risks for developing HAH were significantly higher in patients with thiazide diuretics, regardless of the dose of loop diuretics (OR 2.67, 95{\%} CI 1.13-6.34 and OR 2.31, 95{\%} CI 1.50-5.13 for low- and high-dose loop diuretics, respectively). The association was less apparent in patients without thiazide diuretics (OR 1.29, 95{\%} CI 0.73-2.27 for high-dose loop diuretics alone). Among 206 matched patients, all-cause and cardiac mortality rate was 27{\%} and 14{\%} in non thiazide diuretics users and 50{\%} and 30{\%} in thiazide diuretics users, respectively (HR 2.46, 95{\%} CI 1.29-4.69, p = 0.006 and HR 2.50, 95{\%} CI 1.10-5.67, p = 0.028, respectively) during a mean 19.3 months of follow-up. Conclusions: Thiazide diuretics use, rather than loop diuretics dose, was independently associated with HAH; and mortality was higher in thiazide diuretics users even after statistical matching.",
keywords = "Heart failure, Hyponatremia, Loop diuretics, Thiazide diuretics",
author = "Masahiro Yamazoe and Atsushi Mizuno and Shun Kosaka and Yasuyuki Shiraishi and Takashi Kohno and Ayumi Goda and Satoshi Higuchi and Mayuko Yagawa and Yuji Nagatomo and Tsutomu Yoshikawa",
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T1 - 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

AU - Yamazoe, Masahiro

AU - Mizuno, Atsushi

AU - Kosaka, Shun

AU - Shiraishi, Yasuyuki

AU - Kohno, Takashi

AU - Goda, Ayumi

AU - Higuchi, Satoshi

AU - Yagawa, Mayuko

AU - Nagatomo, Yuji

AU - Yoshikawa, Tsutomu

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: 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. Methods: 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. Results: 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 (<40. mg; without thiazide diuretics), risks for developing HAH were significantly higher in patients with thiazide diuretics, regardless of the dose of loop diuretics (OR 2.67, 95% CI 1.13-6.34 and OR 2.31, 95% CI 1.50-5.13 for low- and high-dose loop diuretics, respectively). The association was less apparent in patients without thiazide diuretics (OR 1.29, 95% CI 0.73-2.27 for high-dose loop diuretics alone). Among 206 matched patients, all-cause and cardiac mortality rate was 27% and 14% in non thiazide diuretics users and 50% and 30% in thiazide diuretics users, respectively (HR 2.46, 95% CI 1.29-4.69, p = 0.006 and HR 2.50, 95% CI 1.10-5.67, p = 0.028, respectively) during a mean 19.3 months of follow-up. Conclusions: Thiazide diuretics use, rather than loop diuretics dose, was independently associated with HAH; and mortality was higher in thiazide diuretics users even after statistical matching.

AB - Background: 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. Methods: 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. Results: 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 (<40. mg; without thiazide diuretics), risks for developing HAH were significantly higher in patients with thiazide diuretics, regardless of the dose of loop diuretics (OR 2.67, 95% CI 1.13-6.34 and OR 2.31, 95% CI 1.50-5.13 for low- and high-dose loop diuretics, respectively). The association was less apparent in patients without thiazide diuretics (OR 1.29, 95% CI 0.73-2.27 for high-dose loop diuretics alone). Among 206 matched patients, all-cause and cardiac mortality rate was 27% and 14% in non thiazide diuretics users and 50% and 30% in thiazide diuretics users, respectively (HR 2.46, 95% CI 1.29-4.69, p = 0.006 and HR 2.50, 95% CI 1.10-5.67, p = 0.028, respectively) during a mean 19.3 months of follow-up. Conclusions: Thiazide diuretics use, rather than loop diuretics dose, was independently associated with HAH; and mortality was higher in thiazide diuretics users even after statistical matching.

KW - Heart failure

KW - Hyponatremia

KW - Loop diuretics

KW - Thiazide diuretics

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