TY  - BOOK
AU  - Hadija Mahamoud Bushahu
AU  - Wajanga, Bahati
AU  - Nkandala, Igembe
AU  - Kidenya, Benson 
TI  - Prevalence and Factors Associated with Sodium and Potassium Abnormalities Among Outpatients With Heart Failure Taking Diuretics at Bugando Medical Centre
PY  - 2019///
CY  - Mwanza, Tanzania:  
PB  - Catholic University of Health and Allied Sciences [CUHAS - Bugando]
KW  - Internal Medicine
N2  - Abstract:

Background: Heart failure is a chronic condition in which the majority of patients need lifelong management, including diuretics. However, diuretics have been associated with electrolyte abnormalities of sodium and potassium. Abnormalities of these electrolytes are reported to be associated with increased mortality and morbidity including cardiac arrhythmia and sudden death. Dysnatremia normally leads to CNS manifestation where confusion, coma, and death may occur. Data about these abnormalities in Tanzanian adults with heart failure are limited. To improve our use of these drugs at BMC, we must understand the prevalence of sodium and potassium abnormalities and the associated factors.

Objective: To determine the prevalence and factors associated with sodium and potassium abnormalities in outpatients with heart failure taking diuretics at Bugando Medical Center.

Methodology: This was a hospital-based cross-sectional study, involving 305 adult outpatients with heart failure on diuretics attending the clinic at BMC from October 2018 to January 2019. After signing the consent form, the Framingham criteria were used to assess patients with heart failure on diuretics for at least one month, and those who met the criteria were enrolled in the study. History taking and physical examination were performed in all patients. Age, duration of diuretic use, type of diuretic used, dosage were assessed. Review of documented chronic illness eg. CKD, DM and HIV and medication history were done through the hospital electronic system. We drew 4mls of a blood sample for serum sodium, serum potassium, and serum creatinine measurement. Attending physicians were informed of all lab results to ensure appropriate clinical management.

Results: A total of 305 participants were enrolled in this study with a mean age of 61years (48- 70), and females formed the majority of the study participants (52.8%). Most participants were in heart failure NYHA class three (87.7%), and the majority of the participants had a history of at least one admission due to heart failure. The commonest symptom presented was muscle weakness (58.8%), lower limb swelling (42%) and air hunger at night (24.6%). On physical examination, the majority had features of cardiomegaly with shifted apex beat (96.7%), lower limb edema (42%) and raised JVP (23.3%). All participants were on diuretics,90.2% on betablockers,82.2% on ACEI and 19.3% on MRA. Hyponatremia was found in 36.7% of participants and was associated with NYHA class 3 and 4(OR=2.46, P= 0.001),heart failure duration (OR=1.01, P= 0.045), lower limb edema (OR=3.68, P= <0.001), confusion (OR=4.04 ,P= 0.021) and muscle weakness (OR=1.89,P=0.012). The prevalence of hypernatremia was 7.9%. The prevalence of hypokalemia was 4.3%. Hypokalemia was associated with elevated SBP per mmHg (OR=1.04,P=0.008) and DBP per mmHg (OR=1.05,P=0.033),age above 50years (OR=1.4,P=0.302),NSAID use (OR =9.69,P = 0.003). The prevalence of hyperkalemia was 19.3%. Factors which were significantly associated with hyperkalemia were heart failure NYHA class 3 and 4 (OR=3.42,P = 0.005), history of confusion (OR = 5.09, P=0.005), nausea (OR=3.00,P=0.005), muscle weakness (OR=2.4, P=0.008), vomiting (OR=5.57,P =0.027), SBP per mmHg (OR=1.03, P= 0.001 ) and DBP per mmHg (OR =1.02, P =0.041), and renal failure (OR =3.29,P= 0.008). In multivariate analysis, lower limb swelling and an increase in creatinine levels were significantly associated with hyponatremia, while an increase in blood pressure and an increase in creatinine levels were associated with hyperkalemia.

Conclusion: Electrolyte abnormalities are common in adults with heart failure seen in the medical outpatient clinic of Bugando Medical Centre. Hyponatremia and hyperkalemia are the most common electrolyte abnormalities. Factors associated with electrolyte abnormalities include NSAIDs use ,renal failure, and more severe heart failure. Doctors should ensure that all patients with these conditions receive regular electrolyte testing. Also, preventive strategies should be put into place to prevent electrolyte abnormalities in this population including the judicious prescription of medications and avoidance of NSAIDs if possible

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