Kidney Week

Abstract: SA-PO1269

Analgesic Use and Stronger Analgesic Therapy Are Associated with Hyponatremia in Patients with Malignancy

Session Information

• Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Miyaguchi, Yuki, Nagoya Shiritsu Daigaku Igakubu Fuzoku Seibu Iryo Center, Nagoya, Aichi Prefecture, Japan

Yuki Miyaguchi, MD

• Murashima, Miho, Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka, Sakai, Osaka Prefecture, Japan

Miho Murashima, MD, PhD

• Suzuki, Kodai, Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan

Kodai Suzuki, MD

• Kasugai, Takahisa, Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan

Takahisa Kasugai, MD

• Tomonari, Tatsuya, Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan

Tatsuya Tomonari

• Mizuno, Masashi, Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan

Masashi Mizuno, MD, PhD

• Suga, Norihiro, Nagoya Shiritsu Daigaku Igakubu Fuzoku Seibu Iryo Center, Nagoya, Aichi Prefecture, Japan

Norihiro Suga, MD, DrMed

• Hamano, Takayuki, Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu, Nagoya, Aichi Prefecture, Japan

Takayuki Hamano, MD, PhD

Background

Pain is a known cause of the syndrome of inappropriate antidiuresis and is common during malignancy treatment. We investigated associations of analgesic use, as a surrogate for pain, with hyponatremia.

Methods

This is a retrospective cohort study among patients with malignancy from 2018 to 2023. Mixed-effects logistic regression examined associations of classes of analgesics, the intensity of analgesic therapy, and their daily dose with the development of hyponatremia (Na ≤130 mmol/L). The intensity of analgesic therapy was classified as no analgesic use, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and NSAIDs, or opioid containing analgesic regimens. Effect modifications by impaired kidney function, proteinuria, and renin-angiotensin system inhibitor (RASi) use were assessed.

Results

We enrolled 5,506 patients. Median age and eGFR were 68 years and 70.2 mL/min/1.73m², respectively, and 1,313 (23.9%) developed hyponatremia. Acetaminophen, NSAIDs, and opioids were each associated with hyponatremia (adjusted OR [95% CI] 1.27 [1.16-1.39], 1.41 [1.27-1.55], and 1.33 [1.15-1.55], respectively). Higher-step analgesics was progressively associated with hyponatremia compared with no analgesic use (OR 1.43 [1.28-1.61] for acetaminophen or NSAIDs, 1.75 [1.53-1.99] for both acetaminophen and NSAIDs, and 2.05 [1.72-2.44] for opioid containing analgesic regimens; p for trend <0.01). Only opioids, not acetaminophen or NSAIDs, showed a dose-response association with hyponatremia (p for trend <0.01). The associations were more pronounced in patients with impaired kidney function (p for interaction 0.03) or proteinuria (p for interaction 0.02), but not with RASi use (p for interaction 0.37).

Conclusion

Analgesic use and stronger analgesic therapy were associated with hyponatremia in patients with malignancy. Patients with more severe pain, as reflected by the need for more intensive analgesic therapy and higher opioid doses, may be at increased risk, particularly those with kidney disease. Adequate pain control may help reduce the risk of hyponatremia.

Funding

• Commercial Support – Kyowa Kirin Co., LTD., Taisho Pharmaceutical Co., LTD., SANWA KAGAKU KENKYUSHO CO., LTD., Torii Pharmaceutical Co., Ltd. AstraZeneca PLC, ONO PHARMACEUTICAL CO., LTD., Nippon Boehringer Ingelheim Co., Ltd., Astellas Pharma Inc., Fuso Pharmaceutical Industries, Ltd., Mochida Pharmaceutical Co., Ltd., Asahi Kasei Pharma Co.