Digoxin associates with mortality in ESRD.

Chan KE, Lazarus JM, Hakim RM
J Am Soc Nephrol. 2010 21 (9): 1550-9

PMID: 20576808 · PMCID: PMC3013530 · DOI:10.1681/ASN.2009101047

The safety of prescribing digoxin in ESRD is unknown. Hypokalemia, which frequently occurs among dialysis patients, may enhance the toxicity of digoxin. Here, we analyzed the association between digoxin prescription and survival in a retrospective cohort using covariate- and propensity score-adjusted Cox models to minimize the potential for confounding by indication. Among 120,864 incident hemodialysis patients, digoxin use associated with a 28% increased risk for death (hazard ratio [HR] 1.28; 95% confidence interval 1.25 to 1.31). Increasing serum digoxin level was also significantly associated with mortality (HR 1.19 per ng/ml increase; 95% confidence interval 1.05 to 1.35). This increased mortality risk with level was most pronounced in patients with lower predialysis serum potassium (K) levels (HR 2.53 [P = 0.01] for K <4.3 mEq/L versus HR 0.86 [P = 0.35] for K >4.6 mEq/L). In conclusion, digoxin use among patients who are on hemodialysis associates with increased mortality, especially among those with low predialysis K concentrations.

MeSH Terms (10)

Aged Cardiotonic Agents Digoxin Female Humans Kidney Failure, Chronic Male Middle Aged Potassium Renal Dialysis

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