Digoxin May Increase Mortality Risk in Hemodialysis Patients

Risk is especially pronounced in those with low pre-dialysis potassium concentrations
By Lindsey Marcellin
HealthDay Reporter

FRIDAY, June 25 (HealthDay News) -- Digoxin use by patients on hemodialysis is linked to increased mortality, particularly in patients who have low pre-dialysis potassium concentrations, according to research published online June 24 in the Journal of the American Society of Nephrology.

Kevin E. Chan, M.D., of Fresenius Medical Care in Waltham, Massachusetts, and colleagues conducted a retrospective cohort study of 120,864 patients on hemodialysis to determine the association of digoxin use with mortality risk in this population.

The researchers found that use of digoxin was associated with a 28 percent increased risk of death, and each 1 ng/mL increase in serum digoxin level was associated with a 19 percent increased risk of death. Hemodialysis patients on digoxin who had pre-dialysis potassium levels of less than 4.3 mEq/L had a greater mortality risk (hazard ratio, 2.53) than those with pre-dialysis potassium levels of greater than 4.6 mEq/L (hazard ratio, 0.86).

"The purported benefits of digoxin may initially seem favorable to the comorbidity profile of dialysis patients, given the high prevalence of atrial fibrillation and hospitalization; however, almost no trials have been conducted to examine whether the hospitalization efficacy, rate control properties, and safety of digoxin translate to patients who are undergoing long-term renal replacement therapy," the authors write.

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