Digoxin use linked to mortality in end-stage renal disease

[okarol]

Digoxin use linked to mortality in end-stage renal disease
June 24, 2010 | Laurie Barclay, MD
Adapted from Medscape Medical News—a professional news service of WebMD

Waltham, MA - Digoxin use is linked to mortality in patients with end-stage renal disease (ESRD), according to the results of a retrospective cohort study reported online June 24, 2010 in the Journal of the American Society of Nephrology [1].

"We were surprised to find that digoxin use increased death risk in dialysis patients, especially in patients on higher doses," lead author Dr Kevin Chan (Fresenius Medical Care North America, Waltham, MA) said in a news release. "Although digoxin has been prescribed by doctors for over 200 years, widespread monitoring studies have not been conducted to examine the penetration, effectiveness, and safety of the drug among patients on dialysis."

To reduce the potential for confounding by indication, the investigators used covariate- and propensity-score-adjusted Cox models to evaluate the association between digoxin prescription and survival in a cohort of 120 864 hemodialysis patients enrolled from more than 1800 clinics across North America and followed for up to four years. Digoxin was prescribed to 4% of the participants.

Digoxin use was associated with a 28% increased mortality risk (95% CI 1.25-1.31). Increase in serum digoxin level was also a significant predictor of death, with a hazard ratio (HR) of 1.19 per ng/mL increase (95% CI 1.05-1.35). Patients with lower predialysis serum potassium levels had the strongest association of increased mortality with digoxin level (HR 2.53 [p=0.01] for serum potassium <4.3 mEq/L vs HR 0.86 [p=0.35] for serum potassium >4.6 mEq/L).

"Digoxin use among patients who are on hemodialysis associates with increased mortality, especially among those with low predialysis potassium," the study authors write.

Limitations of this study include retrospective observational design, use of clinical surveillance data, potential unmeasured confounders, and information bias from misclassification.

"Further research is needed to outline how and if digoxin can be safely prescribed in patients on hemodialysis," Chan said, suggesting that therapeutic options other than digoxin be considered for heart disease in patients starting dialysis. "For patients who remain on digoxin, vigilant monitoring of digoxin and potassium blood levels can minimize the drug's possible side effects."
The study authors report no financial disclosures.

The complete contents of Medscape Medical News, a professional news service of WebMD, can be found at www.medscape.com, a website for medical professionals.

http://www.theheart.org/article/1091185.do

[Des]

What are Digoxin used for?

[cariad]

Digoxin is another name for digitalis, which is for heart conditions.

I was given digitalis in a gobsmacking display of medical malpractice when I was a child. It is highly toxic, and really should not be given to children unless there are no other options. I believe my kidneys were probably salvageable until the doctors decided to treat my congestive heart failure with this medication. I see from the article I should count myself lucky, though. I remember having low potassium in hospital and being giving glasses of orange juice (I would drink anything at that point) to bring it up. Probably meds, too, I don't remember.

[Rerun]

Well for crap sake it has been used for over 200 years!  Did I read that right?  And they are just putting 2 + 2 together?  What are we MICE?

                     

[RightSide]

Evidently digitalis was used safely in most patients--but they never checked whether it was safe for ESRD patients.

Most likely because when these drugs were discovered, ESRD was a death sentence anyway, so the safety of digitalis for ESRD patients was a moot point. 

There may be a whole bunch of classic drugs (chloral hydrate, ether, etc.) whose safety for ESRD patients was never checked because at the time, those with ESRD would tend to die in months anyway.