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Abstract: FR-PO659

Use of Selective Serotonin Reuptake Inhibitors and Risk of Hyponatremia in a Large Health Care System

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Luo, Shengyuan, Johns Hopkins University, Baltimore, Maryland, United States
  • Surapaneni, Aditya L., Johns Hopkins University, Baltimore, Maryland, United States
  • Qiao, Yao (Lucy), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Shin, Jung-Im, Johns Hopkins University, Baltimore, Maryland, United States
  • Inker, Lesley, Tufts Medical Center, Boston, Massachusetts, United States
  • Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States
  • Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States

Selective serotonin reuptake inhibitors (SSRIs) use may increase the risk of hyponatremia. We aimed to quantify hyponatremia risk associated with SSRIs compared to that of serotonin-norepinephrine reuptake inhibitors (SNRIs) and determine whether it differs by eGFR and thiazide diuretic use.


Among primary care patients prescribed SSRIs between January 1, 2004 and January 30, 2017 in the Geisinger Health System, we defined mild and moderate hyponatremia as outpatient blood Na<135mEq/L and <130mEq/L in the 3 months after medication initiation. We then used propensity score matching to pair patients prescribed SSRIs with those prescribed SNRIs and evaluated differences in hospitalizations for hyponatremia (defined by ICD-9 and -10 codes) during the entire course of medication use, overall and stratified by demographic factors, level of eGFR, and thiazide diuretic use.


Among 69,551 patients prescribed SSRIs, 25% had a blood sodium measurement within 3 months after initiation. The risk of mild and moderate hyponatremia was 11% and 3%. In comparison, 25% of the 30,089 patients prescribed SNRIs had monitoring, and the risk of mild and moderate hyponatremia was 7% and 1% (p<0.01 for both comparisons to SSRIs). In the propensity matched cohort, there was no difference in hyponatremia hospitalization overall (1.1% in SSRIs vs. 0.9% in SNRIs; HR=1.08, 95%CI 0.92-1.28; p=0.35), but higher among those with thiazide diuretic use (1.7% in SSRIs vs. 0.9% in SNRIs; HR=1.45, 95%CI 1.00-2.10; p<0.05)(Figure). There was no difference in risk of hospitalized hyponatremia by level of eGFR.


Patients prescribed SSRIs had infrequent monitoring but were at risk for short-term outpatient hyponatremia. Thiazide diuretic use may potentiate the risk of hospitalized hyponatremia with SSRI use.


  • NIDDK Support