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Determining the Risk of Elevated Digoxin Concentrations Following Loading Dose in Patients With Acute and Chronic Kidney Disease.
Young, Mikaela R; Rappaport, Stephen H; Belz, Sarah; Kaufman, David C; Haas, Curtis E.
Afiliación
  • Young MR; Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
  • Rappaport SH; Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
  • Belz S; Wegmans School of Pharmacy, St. John Fisher University, Rochester, NY, USA.
  • Kaufman DC; Children's National, Washington, DC, USA.
  • Haas CE; School of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Ann Pharmacother ; 58(1): 37-43, 2024 Jan.
Article en En | MEDLINE | ID: mdl-37042295
BACKGROUND: The optimal loading dose of digoxin in patients with reduced kidney function is unknown. Tertiary references recommend reduced loading doses; however, these recommendations are based on immunoassays that are falsely elevated by the presence of digoxin-like immunoreactive substances, a problem that is minimized in modern assays. OBJECTIVE: To determine whether chronic kidney disease (CKD) or acute kidney injury (AKI) is associated with supratherapeutic digoxin concentrations after a digoxin loading dose. METHODS: A retrospective analysis on patients who received an intravenous loading dose of digoxin with a digoxin concentration collected 6 to 24 hours after the end of the dose. Patients were stratified into 3 groups: AKI, CKD, and non-AKI/CKD (NKI) based on glomerular filtration rate and serum creatinine. The primary outcome was frequency of supratherapeutic digoxin concentrations (>2 ng/mL) and secondary outcomes included frequency of adverse events. RESULTS: A total of 146 digoxin concentrations were included (AKI = 59, CKD = 16, NKI = 71). Frequencies of supratherapeutic concentrations were similar between groups (AKI: 10.2%, CKD: 18.8%, NKI: 11.3%; P = 0.61). Pre-planned logistic regression demonstrated no significant relationship between kidney function group and the development of a supratherapeutic concentration (AKI: odds ratio [OR]: 1.3, 95% confidence interval [CI]: 0.4-4.5; CKD: OR 4.3, 95% CI: 0.7-23). CONCLUSION AND RELEVANCE: This is the first study in routine clinical practice evaluating the relationship between kidney function and digoxin peak concentrations that differentiates AKI from CKD. We did not find a relationship between kidney function and peak concentrations; however, the group with CKD was underpowered.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Tipo de estudio: Etiology_studies / Guideline / Risk_factors_studies Límite: Humans Idioma: En Revista: Ann Pharmacother Asunto de la revista: FARMACOLOGIA / TERAPIA POR MEDICAMENTOS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Tipo de estudio: Etiology_studies / Guideline / Risk_factors_studies Límite: Humans Idioma: En Revista: Ann Pharmacother Asunto de la revista: FARMACOLOGIA / TERAPIA POR MEDICAMENTOS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos