Abstract: FR-PO0375
Diuretic Use Is Associated with Fatigue Independent of Micronutrient Deficiencies
Session Information
- Hypertension and CVD: Clinical - 2
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States
- Vu, Christine, Texas Tech University Health Sciences Center Jerry H Hodge School of Pharmacy Lubbock, Lubbock, Texas, United States
- Perkins, Aaron Rode, Texas Tech University Health Sciences Center Jerry H Hodge School of Pharmacy Lubbock, Lubbock, Texas, United States
- Yang, Hui, Texas Tech University Health Sciences Center Jerry H Hodge School of Pharmacy Lubbock, Lubbock, Texas, United States
- Razjouyan, Javad, Baylor College of Medicine, Houston, Texas, United States
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
- Alvarez, Carlos A., Texas Tech University Health Sciences Center Jerry H Hodge School of Pharmacy Lubbock, Lubbock, Texas, United States
Background
People with kidney disease are commonly prescribed thiazide and loop diuretics. Diuretics increase urinary losses of several micronutrients, which can cause fatigue. We hypothesized that micronutrient deficiencies explain the association of thiazide or loop diuretic use with fatigue.
Methods
This retrospective cohort study included participants in the NIH All of Us Research Program from 2019-2022 who self-reported fatigue and had a measured level of magnesium, zinc, thiamine, pyridoxine, and/or tocopherol within 5 years of cohort enrollment. Tocopherol was treated as a negative control, as this is not affected by diuretics. Active prescriptions for thiazide or loop diuretics were identified within 1 year prior to cohort entry. Micronutrient deficiencies were defined as magnesium <1.7 mg/dL, zinc <80 mcg/dL, thiamine <74 nmol/L, pyridoxine <5 mcg/L, and tocopherol <5.7 mg/L. Fatigue was prospectively ascertained at cohort entry as none, mild, moderate, severe, or very severe fatigue within the last 7 days. Multivariable logistic regression assessed associations of diuretic use with fatigue and whether this was affected by micronutrient deficiencies.
Results
Of 87,326 participants, 11,930 (13.7%) were prescribed a thiazide or loop diuretic at the index date. Those who received a diuretic were older (62 [12] vs 54 [16] years) and more likely to have hypertension (92% vs 61%), diabetes (51% vs 31%), heart failure (31% vs 9%), or an eGFR <60 (33% vs 17%), P<.001 for each. Diuretic prescription was associated with deficiencies of magnesium (11% vs 9%, P<.001) and pyridoxine (20% vs 15%, P=.006). Fatigue severity was associated with magnesium, thiamine, and pyridoxine deficiency (Fig 1A). Diuretic use was independently associated with fatigue (aOR 1.2, 95% CI 1.1-1.2 for mild/moderate fatigue and aOR 1.1, 95% CI 1.0-1.2 for severe/very severe fatigue), and magnesium and pyridoxine deficiencies did not nullify this association (Fig 1B).
Conclusion
Future studies should determine other mechanisms that may explain the association of thiazide and loop diuretic use with fatigue.
Funding
- Other NIH Support