Desmopressin is prescribed by physicians for adults with nocturia. For this indication, a meta-analysis identified that desmopressin use was associated with higher odds of hyponatremia compared to placebo, with approximately 5% of patients prescribed desmopressin experiencing hyponatremia. However, recent cohort study presented that desmopressin was associated with a marked increased rate of subsequent hyponatremia (HR 12.11) compared to use of other medications indicated for lower urinary tract symptoms. Patients receiving desmopressin for the treatment of nocturnal enuresis in clinical practice often do not experience hyponatremia. This may be attributed to the recent development of low-dose formulations of desmopressin aimed at overcoming hyponatremia associated with desmopressin use.

We utilized data from the national health claims database of the NHIS, a mandatory universal health insurance program that provides comprehensive medical care coverage to the majority of the population of The Republic of Korea (approximately 51 million people) 10. We identified diagnoses using the International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes.
From the National Health Insurance Service database, we collected and analyzed data pertaining to desmopressin and hyponatremia in the entire Korean adult population with benign prostate hyperplasia between January 2011 and December 2012. These patients were followed up until December 2020. We tested the effect of desmopressin on the risk of hyponatremia using propensity score-matched Cox proportional hazard regression models and Kaplan-Meier survival analysis. Adjustment covariates included age, use of medication, a history of hypertension (HTN), myocardial infarction (MI), congestive heart failure (CHF), peripheral vascular disease (PVD), diabetes mellitus (DM), renal disease (RD), or malignant neoplasm. The medication history and co-morbidities were determined using data collected between 6 months prior to diagnosis and 12 months after diagnosis.

All inclusion and exclusion criteria were met by 33,533 patients with benign prostate hyperplasia. In the unadjusted cohort, the incidence of hyponatremia in the desmopressin (n= 1,406), alpha-blocker (n=16,019) and alpha blocker with antimuscarinic (16,128) cohorts were 6.00%, 4.53% and 5.02%, respectively. After propensity score matching, the risk of hyponatremia did not significantly differ between the three cohorts (HR 1.273, 95% CI 0.988-1.640, p=0.062). Age (HR 1.652, p<0.001) medical history of chronic heart failure (HR 2.532, p=0.016), peripheral vascular disease (HR 2.251, p=0.012) and renal disease (HR 2.383, p= 0.001) were associated with hyponatremia. There was no significant difference in the cumulative probability of hyponatremia-free among those who received desmopressin compared to those who received alpha blocker or antimuscarinic agent for lower urinary tract symptom (p > 0.05).

The use of desmopressin has been shown to increase the risk of hyponatremia, although this appears to be associated with certain underlying conditions in patients.

The study findings indicate that the use of desmopressin is not associated with the risk of hyponatremia.

Continence 12S (2024) 101534
DOI: 10.1016/j.cont.2024.101534