Sodium-containing medications and laxative use among older primary care patients requiring sodium restriction: findings from the LAXAP study

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Abstract Background High sodium intake is a global health concern, contributing to conditions like hypertension, chronic kidney disease (CKD), and cardiovascular diseases (CVDs). While efforts have been made to reduce sodium in diets, the sodium content in medications is often overlooked, posing additional risks. High sodium content is generally associated with specific pharmaceutical formulations rather than being an inherent component of most medications, particularly effervescent formulations containing sodium salts and macrogol formulations with added electrolytes. This is especially important for older patients, who not only require sodium-restricted diets but also have additional comorbidities such as constipation, complicating sodium management due to multiple medications. This study aims to estimate the proportion of patients aged 60 years or older attending primary care in Spain with conditions or treatments associated with sodium restriction and to describe constipation, laxative use, and exposure to sodium-containing medications in this population. Methods A cross-sectional, observational, non-randomized study was conducted in primary care centers across Spain. Data collection occurred between October 3rd, 2023, and December 29th, 2023. Patients aged 60 years or older attending primary care consultations in person were consecutively included by order of attendance. Clinical and demographic data from 448 patients were analyzed. Results The study involved 448 patients with an average age of 72.3 years. Of these patients, 80.8% were diagnosed with at least one condition or were under treatment requiring reduced sodium intake, and 74.1% had a documented medical recommendation for a low-sodium diet. Among these patients, 29.7% reported experiencing constipation. Notably, more than 2.5% of the patients had constipation, a condition requiring reduced sodium intake or a low-sodium diet prescription and were also taking laxatives with high sodium content. Furthermore, over 6.6% of the patients were receiving sodium through concomitant medications (excluding laxatives), despite their need for sodium restrictions. Conclusions Sodium intake from medications is relatively common in patients requiring low-sodium diets and may pose a significant risk. The findings highlight the need for careful medication management in older and comorbid populations, including the avoidance of effervescent formulations and formulations with added electrolytes when suitable alternatives are available, to help prevent adverse health outcomes. Study registration ClinicalTrials.gov identifier NCT06121583 Registration date 08 November 2023.