|The following article features coverage from Kidney Week 2019. Click here to read more of Renal & Urology News’ conference coverage.|
WASHINGTON—Use of selective serotonin reuptake inhibitors (SSRIs) is associated with a higher short-term risk of hyponatremia compared with use of serotonin-norepinephrine reuptake inhibitors (SNRIs), investigators reported at the American Society of Nephrology’s 2019 Kidney Week conference.
In addition, among concurrent users of thiazide diuretics, SSRI use is associated with a greater risk of hospitalization with hyponatremia compared with SNRI use.
The findings are from a study of 69,551 patients prescribed an SSRI and 30,089 patients prescribed an SNRI. Of those prescribed an SSRI, only 17,066 (25%) had at least one outpatient sodium measurement in the three months following prescription, and the risks for mild and moderate hyponatremia (serum sodium levels below 135 and below 130 mEq/L, respectively) among these patients were 11.2% and 2.5%. Shengyuan Luo, MBBS, MHS, of Johns Hopkins University in Baltimore, and colleagues reported in a poster presentation. By comparison, 7,527 (25%) of the patients prescribed an SNRI had at least one outpatient sodium measurement in the first three months, and the risk for mild and moderate hyponatremia was 7.3% and 1.2%, respectively.
After propensity score matching, the odds of mild and moderate hyponatremia, respectively, was significantly 28% and 46% greater among those prescribed an SSRI compared with those prescribed an SNRI. Among patients on concurrent thiazide diuretic therapy, SSRI use was significantly associated with a 45% increased risk of hospitalization with hyponatremia compared with SNRI use.
Dr. Luo and colleagues observed no significant difference in risk of hospitalized hyponatremia by level of estimated glomerular filtration rate.
“Despite a potentially higher hyponatremia risk, the monitoring of blood sodium is uncommon among patients who were prescribed an SSRI,” Dr Luo told Renal & Urology News. “Caution against hyponatremia may be needed in SSRI users, especially among those with concurrent thiazide diuretic use. There may be a need to reassess optimal antihypertensive therapy in those receiving an SSRI.”
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Luo S, Surapaneni AL, Qiao Y, et al. Use of selective serotonin reuptake inhibitors and risk of hyponatremia in a large health care system. Presented at the American Society of Nephrology’s 2019 Kidney Week conference held November 5 to 10 in Washington, DC. Abstract FR-PO659.