A cross-sectional study of hyponatraemia among elderly patients with heart failure in Uganda

Abstract

BackgroundHyponatraemia is a common electrolyte disturbance among older patients. We determined the prevalence of and factors associated with hyponatraemia among older patients with predominantly acute decompensated heart failure attending a tertiary hospital in Kampala, Uganda.ObjectivesMain study aim: (1) to determine the prevalence of hyponatraemia among patients aged 60 years and above with heart failure attending Mulago National Referral Hospital; (2) to describe the factors associated with hyponatraemia among patients aged 60 years and above with heart failure attending Mulago National Referral Hospital.SettingThe study was conducted in one tertiary hospital located in the northeast of Kampala, Uganda.Participants400 adults aged 60 years and above were identified for the study. Of these, 188 were excluded as they did not fulfil the inclusion criteria and one declined to participate, leaving a final study group of 211 older adults aged 60 years and above, with a clinical diagnosis of heart failure using Framingham's criteria.ResultsThe prevalence of hyponatraemia was 24.2% (51/211). Hyponatraemia was mainly found in patients with mild-to-moderate heart failure, New York Heart Association classes 2 and 3. Of the 51 patients with hyponatraemia, 27 (52.9%) had mild hyponatraemia, while 24 (47.1%) had moderate to severe hyponatraemia of 130–125 mmol/L. History of vomiting (OR=2.94, 95% CI 1.29 to 6.70, p=0.010) and use of loop diuretics (OR=2.71, 95% CI 1.13 to 6.52, p=0.026) were identified as independent factors associated with hyponatraemia among older patients with heart failure.ConclusionsOur study revealed a relatively high prevalence of hyponatraemia among older patients with mild to moderate heart failure. Patients presenting with a history of vomiting from any cause or use of loop diuretics were more likely to have hyponatraemia.

Furosemide and spironolactone doses and hyponatremia in patients with heart failure

“…There is a possibility that metabolic and other effects of thiazide diuretics may vary in specific populations which should be accounted for in future studies. Several studies have linked the use of loop diuretics to hyponatremia [15,33]. Loop diuretics promote natriuresis and water loss through the inhibition of sodium chloride reabsorption at the ascending limb of Henle's loop [17].…”

“…This therapy is prescribed to patients with chronic renal failure [ 14 ], arterial hypertension [ 14 ], cirrhosis [ 6 ], and especially to those with symptomatic heart failure (HF) [ 9 ]. Thiazides, loop diuretics, and potassium sparing diuretics induce water and salt excretion [ 12 , 14 , 15 ] and may promote sodium loss through renal effects [ 16 ]. It has been suggested that some diuretic combinations may additionally increase the risk of hyponatremia [ 17 , 18 ].…”

Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

“…Geriatrics studies in Uganda have mainly focused on: exploring geriatric education needs, knowledge and attitudes of health workers towards geriatric care services (where 69% of them lacked geriatric training and 80% had poor to fair knowledge of geriatric care (12)), the impact of HIV among older adults (20), older persons as caregivers to people infected and affected by HIV/AIDS (21), and loneliness among older adults in Uganda (22). Other studies have focused on: health care access challenges faced by the elderly (23,24), hyponatraemia among older adults (25), and perceptions of anaemia among the older population in Southwest Uganda (26).…”

Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

“…With regards to geriatric research, studies have mainly focused on: exploring geriatric education needs, knowledge and attitudes of health workers towards geriatric care services (where 69% lacked geriatric training and 80% had poor to fair knowledge of geriatric care (11)), the impact of HIV among old people (15), older persons as caregivers to people infected and affected by HIV/AIDS (16), and loneliness among the aged in Uganda (17). Other studies have focused on: health care access challenges by the elderly (18,19), hyponatraemia among old patients (20), and perceptions of anaemia among the older population in Southwest Uganda (21). The readiness of Uganda's public health system to provide geriatric friendly care services to its ageing population remains underexplored.…”