Digoxin Associates with Mortality in ESRD

• Published in: Journal of the American Society of Nephrology Vol. 21; no. 9; pp. 1550 - 1559
• Main Authors: CHAN, Kevin E, LAZARUS, J. Michael, HAKIM, Raymond M
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.09.2010
• Subjects: Aged; Biological and medical sciences; Cardiotonic Agents - adverse effects; Clinical Epidemiology; Digoxin - administration & dosage; Digoxin - adverse effects; Digoxin - blood; Female; Humans; Kidney Failure, Chronic - mortality; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Potassium - blood; Renal Dialysis; Renal failure; Kidney disease; Cardiotonic agent; Nephrology; Urinary system disease; Chronic renal failure; Digoxin; Mortality; Terminal stage; Glycoside; Epidemiology; Digitalis drug; Urology
• ISSN: 1046-6673; 1533-3450
• 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.