Supportive Care in Cancer

, Volume 26, Issue 1, pp 213–222 | Cite as

Prevalence of hyponatremia in inpatients with incurable and life-limiting diseases and its association with physical symptoms—a retrospective descriptive study

  • Kerstin Kremeike
  • Ricarda M. L. Wetter
  • Volker Burst
  • Raymond Voltz
  • Kathrin Kuhr
  • Steffen T. SimonEmail author
Original Article



Hyponatremia is a common electrolyte abnormality seen in hospitalized patients. It may cause a variety of symptoms and is associated with longer hospitalizations and higher mortality. However, to date, only little is known about the extent of hyponatremia in patients with incurable diseases and whether it is associated with physical symptoms in this patient group. This study aims to describe the prevalence of hyponatremia, associated symptoms, and symptom intensity in inpatients with hyponatremia receiving specialist palliative care (SPC).


This is a retrospective study. Demographic and clinical data as well as symptoms, scored symptom intensity, and laboratory values were collected. All inpatients of a large German University Hospital receiving SPC in 2013 with documented sodium values were included.


In 2013, 789 inpatients received SPC of which 710 had documented sodium values. The prevalence of hyponatremia was 38.7% (275/710). A mild degree showed 220 (31,0%), 44 (6.2%) had a moderate, and 11 (1.6%) a severe form. Hyponatremia patients experienced significantly more symptoms than normonatremic patients (mean = 7.71 vs 6.63; p < 0.001). Breathlessness, depressiveness, nausea, vomiting, poor appetite, constipation, and weakness were significantly more frequent in patients with hyponatremia. Furthermore, hyponatremia severity was associated with higher symptom intensity (mean = 13.29 vs 11.28; p < 0.001).


More than one third of all SPC patients showed a hyponatremia, and the hyponatremia grade was associated with symptom burden and symptom intensity. A prospective analysis is needed to further examine this association and the possible influence of hyponatremia correction on symptom burden reduction.


Hyponatremia Palliative care Symptoms Prevalence 



We thank Mr. Abdelghani Bensaid, Information Technology, University Hospital Cologne, for his support to identify SPC patients and to determine length of stay and in-hospital mortality.

Compliance with Ethical Standards

It was approved by the Ethics Committee of the University Hospital Cologne (No. 15-197).


This study was funded by an unrestricted research grant from Otsuka Pharmaceutical Europe Ltd. (OPEL; manufacturer of a drug to treat hyponatremia). The funder had no influence on the study design and the collection of data and did not have any role in execution, analyses, interpretation of the data, decision to submit results, or writing the article.

Conflict of Interests

Dr. Burst is a consultant and his institution received research support from Otsuka for the Hyponatremia Registry. He received travel support and fees for data review activities, and serves on a speakers’ bureau for Otsuka.

Dr. Simon is a consultant and his institution received the unrestricted research grant from Otsuka for this study.

All other authors declare no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Kerstin Kremeike
    • 1
    • 2
  • Ricarda M. L. Wetter
    • 1
    • 2
  • Volker Burst
    • 3
  • Raymond Voltz
    • 1
    • 2
    • 4
    • 5
  • Kathrin Kuhr
    • 6
  • Steffen T. Simon
    • 1
    • 2
    • 4
    Email author
  1. 1.Department of Palliative MedicineUniversity Hospital CologneCologneGermany
  2. 2.Centre for Integrated Oncology Köln Bonn (CIO)University Hospital CologneCologneGermany
  3. 3.Department 2 of Internal Medicine, NephrologyUniversity Hospital CologneCologneGermany
  4. 4.Clinical Trials Center Cologne, (ZKS)KölnGermany
  5. 5.Center for Health Services Research (ZVFK), Medical FacultyUniversity of CologneCologneGermany
  6. 6.Institute of Medical Statistics, Informatics and Epidemiology (IMSIE)University Hospital CologneCologneGermany

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