Women on diuretics have a higher risk of hospital admission because of hyponatremia than men

Linda C. Hendriksen*, Paul D. van der Linden, Ron M.C. Herings, Bruno H. Stricker, Loes E. Visser

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
40 Downloads (Pure)


Purpose: Recent studies suggest that women are more susceptible to diuretic-induced hyponatremia resulting in hospital admission than men. The aim of this study was to confirm whether these sex differences in hyponatremia-related hospital admissions in diuretic users remain after adjusting for several confounding variables such as age, dose, and concurrent medication. Methods: In a case–control design nested in diuretic users, cases of hyponatremia associated hospital admissions between 2005 and 2017 were identified from the PHARMO Data Network. Cases were 1:10 matched to diuretic users as controls. Odds ratios (OR) with 95%CIs were calculated for women versus men and adjusted for potential confounders (age, number of diuretics, other hyponatremia-inducing drugs, chronic disease score) using unconditional logistic regression analysis. A subgroup analysis was performed for specific diuretic groups (thiazides, loop diuretics and aldosterone antagonists). Results: Women had a statistically significantly higher risk of a hospital admission associated with hyponatremia than men while using diuretics (OR 1.86, 95%CI 1.64–2.11). Adjusting for the potential confounders resulted in an increased risk for women compared to men (ORadj 2.65, 95% CI 2.31–3.04). This higher risk in women was also seen in the three subgroup analyses after adjustment. Conclusion: Our findings show a higher risk of hyponatremia-related hospital admission in women than men while using diuretics. Further research is needed to understand the underlying mechanism of this sex difference to be able to provide sex-specific recommendations.

Original languageEnglish
Pages (from-to)635-642
Number of pages8
JournalPharmacoepidemiology and Drug Safety
Issue number6
Publication statusPublished - Jun 2023

Bibliographical note

Funding Information:
This study received financial support from ZonMw (project number 849200006).

Publisher Copyright:
© 2023 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.


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