Kidney Week

Abstract: PUB442

Antineoplastic Agents Associated with Hyponatremia and Modifiable Factors for the Associations

Session Information

• Publication Only

Category: Onconephrology

• 1700 Onconephrology

Authors

• Miyaguchi, Yuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Yuki Miyaguchi

• Murashima, Miho, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Miho Murashima, MD, PhD

• Suzuki, Kodai, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Kodai Suzuki, MD

• Kasugai, Takahisa, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Takahisa Kasugai, MD

• Tomonari, Tatsuya, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Tatsuya Tomonari

• Mizuno, Masashi, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Masashi Mizuno, MD, PhD

• Hamano, Takayuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan

Takayuki Hamano, MD, PhD

Background

Hyponatremia is associated with worse outcomes among patients with malignancy. In our previous study, we found that bortezomib (BOR), and immune checkpoint inhibitors (ICI) were significantly associated with hyponatremia. We aimed to identify modifiable factors for the associations.

Methods

This is a retrospective cohort study on patients with malignancy on anti-neoplastic agents at Nagoya City University Hospital from 2018 to 2020. We utilized logistic regression analyses using data at the time of each patient's lowest serum sodium concentration to examine the association of BOR and ICI with hyponatremia (Na ≤130 mmol/L) and effect modifications by rening-angiotensin system inhibitors (RASi), non-steroidal anti-inflammatory agents (NSAIDs) and proton pump inhibitors (PPI), as these factors are potentially modifiable.

Results

We included 2644 patients. Median age was 69 (58-75) years and median eGFR was 72.9 (58.1-88.1) mL/min/1.73m². Of these, 657(24.9%) developed hyponatremia and the lowest serum sodium concentration was 104 mmol/L. The use of BOR and ICI was associated with hyponatremia (OR 2.95 [1.25-6.97] and 2.40 [1.53-3.76], respectively) The incidence of hyponatremia was particularly high with simultaneous use of RASi and BOR (OR 48.6 [1.79-1330.70]), and with the use of PPI and ICI (OR 3.05 [1.69-5.49]) (p for interaction 0.098 and 0.05, respectively). No effect modifications were observed by NSAIDs. A sensitivity analysis using a mixed effects logistic regression showed similar associations and effect modifications.

Conclusion

Hyponatremia was common among those with malignancy. The concomitant use of BOR with RASi and ICI with PPI was especially associated with higher incidence of hyponatremia. Avoiding the contamitant use of RASi with BOR and use of PPI with ICI might reduce the incidence of hyponatremia.