For patients with kidney disease on dialysis, thewidely used heart medication digoxin may lead to an increased risk of premature death,according to a study appearing in an upcoming issue of the Journal of the AmericanSociety of Nephrology (JASN).
The researchers monitored more than 120,000 dialysis patients drawn from over 1,800clinics across North America for up to four years. We were surprised to find that digoxinuse increased death risk in dialysis patients, especially in patients on higher doses,comments Kevin Chan, MD, MSci, Fresenius Medical Care North America, Waltham,MA.
The risk of death was 28 percent higher for dialysis patients taking digoxin, afteradjustment for other factors. The increase in risk was greater for patients with higherlevels of digoxin in their blood and in patients who had lower serum potassium levels,which is a well-known factor that contributes to digoxin toxicity.
Over 400,000 Americans currently live with dialysis for end-stage renal disease, which initself, magnifies the risk for concurrent heart disease. When heart disease is present, it issometimes treated with digoxin, for the of regulation heart rate in atrial fibrillation or theaugmentation of overall pump function in heart failure.
Four percent of dialysis patients in the study were taking digoxin. Although digoxin hasbeen prescribed by doctors for over 200 years, widespread monitoring studies have notbeen conducted to examine the penetration, effectiveness, and safety of the drugamong patients on dialysis, says Dr. Chan.
The new and national study raises concern that digoxin could in fact be dangerous whenused in kidney disease patients on dialysis. However, Dr. Chan emphasizes that sincethe study was based on clinical surveillance data, the findings cannot be consideredconclusive. Further research is needed to outline how and if digoxin can be safelyprescribed in patients on hemodialysis, he says.
In the meantime, Dr. Chan encourages doctors, patients, and healthcare providers toreconsider the benefits of digoxin when alternative treatments are available for heartdisease in patients starting dialysis. He adds, For patients who remain on digoxin,vigilant monitoring of digoxin and potassium blood levels can minimize the drug'spossible side effects.