Risk of electrolyte disorders, syncope and falls in patients taking thiazide diuretics: results of a cross-sectional study.

Abstract

BACKGROUND\nThiazide diuretics are a mainstay in the management of hypertension and often associated with dyselectrolytemias. We investigated prevalence of and risk factors for hyponatremia and hypokalemia in thiazide users, substance-specific differences and the association of thiazides with syncope and falls.\n\n\nMETHODS\nIn this cross-sectional analysis all patients admitted to an interdisciplinary emergency department in Switzerland between January 1st 2017 and December 31st 2018 with measurements of serum sodium and potassium were included. Data regarding serum electrolytes and creatinine were analyzed to classify for dysnatremias, dyskalemias and acute kidney injury. Chart reviews were performed to screen for syncope or falls.\n\n\nRESULTS\nA total of 1,604 patients (7.9%) took thiazides. Acute kidney injury was significantly more common in thiazide users (22.1 vs. 7%, p<0.0001). Hyponatremia (22.1 vs. 9.8%, p<0.0001) and hypokalemia (19 vs. 11%, p<0.0001) were more frequent with thiazides. Thiazide use together with higher age and female sex were independent predictors of hyponatremia and hypokalemia.A dose-dependent effect was found for electrolyte disorders and there was a variance in risk between the investigated substances with chlorthalidone bearing the highest and hydrochlorothiazide the lowest risk. Patients taking thiazide diuretics had significantly more episodes of syncope and falls.\n\n\nCONCLUSIONS\nThiazide use is a clear risk factor for hyponatremia and hypokalemia. The effect appears to be dose-dependent and highly variable depending on the substance. Syncope and falls seem to be causally related to thiazide use. Especially in elderly, female and patients prone to falls, the use of thiazide diuretics should therefore be thoroughly questioned.