Hyponatremia: incidence, risk factors, and consequences in the elderly in a home-based primary care program

被引:32
作者
Ganguli, Anirban [1 ]
Mascarenhas, Ryan C. [2 ]
Jamshed, Namirah [3 ]
Tefera, Eshetu [3 ]
Veis, Judith H. [3 ]
机构
[1] Hosp Univ Penn, Philadelphia, PA 19104 USA
[2] Ochsner Med Ctr, New Orleans, LA USA
[3] Medstar Washington Hosp Ctr, Washington, DC USA
关键词
hyponatremia; risk factors; geriatric outcomes; OLDER-ADULTS; MILD HYPONATREMIA; BLOOD-PRESSURE; HEART-FAILURE; SERUM SODIUM; FALLS; MORTALITY; FRACTURE; OUTCOMES; FRAILTY;
D O I
10.5414/CN108453
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Aims: To determine the incidence, risk factors, etiology, and associations of hyponatremia in community-dwelling elderly with geriatric morbidity and mortality. Materials: Elderly participants of a single center home-based primary care program were included. Method: Retrospective chart review was conducted on demographic and clinical variables, comorbid diseases, frailty by Fried criteria and biochemical tests over a 1-year period. Primary outcome measure was a composite of falls, fractures due to falls, and hospitalization witnessed within the first year of enrollment into the program. Secondary outcome was all-cause mortality. Results: The study population (n = 608) had a mean age of 84.3 +/- 9.3 years and was largely female (77.1%) and African-American (89.5%). Mean follow-up was 41.5 months. Frailty was seen in 44.4%. Incidence of all-cause mortality was 26.9%. Initial hyponatremia occurred in 8.71% (n = 53), and persistent hyponatremia (> 6 months of low serum sodium) in 4.1% (n = 25) of the study population. The major causes of hyponatremia included multiple potential causes, idiopathic syndrome of inappropriate antidiuretic hormone (SIADH) and medications (thiazides and selective serotonin reuptake inhibitor (SSRI)). Primary outcome was independently associated with frailty (Odds ratio (OR) of 2.33) and persistent but not initial hyponatremia (OR 3.52). Secondary outcome was independently associated with age > 75 years (OR 2.88) and Afro-American race (OR 2.09) only but not to frailty or hyponatremia. Conclusions: Hyponatremia is common in home-bound elderly patients and its persistence independently contributes to falls, fractures, and hospitalization but not mortality. Our study highlights a new association of hyponatremia with frailty and underscores the need to study time-dependent association of hyponatremia with epidemiological outcomes.
引用
收藏
页码:75 / 85
页数:11
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