Matthew A Weir1, Jamie L Fleet2, Chris Vinden3, Salimah Z Shariff4, Kuan Liu4, Haoyuan Song5, Arsh K Jain6, Sonja Gandhi, William F Clark1, Amit X Garg7. 1. 1] Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada [2] Kidney Clinical Research Unit, Western University, London, Ontario, Canada. 2. Kidney Clinical Research Unit, Western University, London, Ontario, Canada. 3. Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada. 4. 1] Kidney Clinical Research Unit, Western University, London, Ontario, Canada [2] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 5. Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. 6. 1] Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada [2] Kidney Clinical Research Unit, Western University, London, Ontario, Canada [3] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 7. 1] Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada [2] Kidney Clinical Research Unit, Western University, London, Ontario, Canada [3] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [4] Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Abstract
OBJECTIVES: Bowel preparations are commonly prescribed drugs. Case reports and our clinical experience suggest that sodium picosulfate bowel preparations can precipitate severe hyponatremia in some older adults. At present, this risk is poorly quantified. We investigated the association between sodium picosulfate use and the risk of hyponatremia in older adults. METHODS: We conducted a population-based retrospective cohort study using six linked administrative databases in Ontario, Canada. All Ontario residents over the age of 65 years who filled an outpatient bowel preparation prescription before colonoscopy were eligible. We enrolled new users of either sodium picosulfate (n=99,237) or polyethylene glycol (n=48,595). The primary outcome was hospitalization with hyponatremia within 30 days of the bowel preparation assessed by database codes. The secondary outcomes were hospitalization with urgent head computed tomography (CT) (a proxy for acute central nervous system disturbance) and all-cause mortality. RESULTS: The baseline characteristics of the two groups, including patient demographics, comorbid conditions, and concomitant medications, were nearly identical. Compared with polyethylene glycol, sodium picosulfate was associated with a higher risk of hospitalization with hyponatremia (absolute risk increase: 0.05%, 95% confidence interval (CI): 0.04-0.06%, relative risk (RR): 2.4, 95% CI: 1.5-3.9), but not hospitalization with urgent CT head (RR: 1.1, 95% CI: 0.7-1.4) or mortality (RR: 0.9, 95% CI: 0.7-1.3). CONCLUSIONS: Sodium picosulfate bowel preparations lead to more hyponatremia than polyethylene glycol. There was no evidence of increased risk of acute neurologic symptoms or mortality. The absolute increase in risk of hospitalization with hyponatremia remains low but may be avoidable through appropriate fluid intake or preferential use of polyethylene glycol in some older adults.
OBJECTIVES: Bowel preparations are commonly prescribed drugs. Case reports and our clinical experience suggest that sodium picosulfate bowel preparations can precipitate severe hyponatremia in some older adults. At present, this risk is poorly quantified. We investigated the association between sodium picosulfate use and the risk of hyponatremia in older adults. METHODS: We conducted a population-based retrospective cohort study using six linked administrative databases in Ontario, Canada. All Ontario residents over the age of 65 years who filled an outpatient bowel preparation prescription before colonoscopy were eligible. We enrolled new users of either sodium picosulfate (n=99,237) or polyethylene glycol (n=48,595). The primary outcome was hospitalization with hyponatremia within 30 days of the bowel preparation assessed by database codes. The secondary outcomes were hospitalization with urgent head computed tomography (CT) (a proxy for acute central nervous system disturbance) and all-cause mortality. RESULTS: The baseline characteristics of the two groups, including patient demographics, comorbid conditions, and concomitant medications, were nearly identical. Compared with polyethylene glycol, sodium picosulfate was associated with a higher risk of hospitalization with hyponatremia (absolute risk increase: 0.05%, 95% confidence interval (CI): 0.04-0.06%, relative risk (RR): 2.4, 95% CI: 1.5-3.9), but not hospitalization with urgent CT head (RR: 1.1, 95% CI: 0.7-1.4) or mortality (RR: 0.9, 95% CI: 0.7-1.3). CONCLUSIONS:Sodium picosulfate bowel preparations lead to more hyponatremia than polyethylene glycol. There was no evidence of increased risk of acute neurologic symptoms or mortality. The absolute increase in risk of hospitalization with hyponatremia remains low but may be avoidable through appropriate fluid intake or preferential use of polyethylene glycol in some older adults.
Authors: Sonja Gandhi; Eric McArthur; Jeffrey P Reiss; Muhammad M Mamdani; Daniel G Hackam; Matthew A Weir; Amit X Garg Journal: Can J Kidney Health Dis Date: 2016-04-11
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Authors: Sang Hoon Kim; Ji Hyeong Kim; Bora Keum; Han Jo Jeon; Se Hyun Jang; Seong Ji Choi; Seung Han Kim; Jae Min Lee; Hyuk Soon Choi; Eun Sun Kim; Yoon Tae Jeen; Hong Sik Lee; Hoon Jai Chun; Chang Duck Kim Journal: Gastroenterol Res Pract Date: 2020-03-03 Impact factor: 2.260