Taking a common heart drug called digoxin may increase the risk of an early death for some people with kidney disease, reports a new study. However, we can't yet be certain that digoxin, and not other factors, was responsible for this increase in risk.
If you have advanced kidney failure (also called end-stage renal disease) your kidneys have lost most, or all, of their filtering ability and can't make urine properly. This means you need either a kidney transplant or dialysis, which involves using a machine to filter waste products out of your blood.
Many people with kidney failure also have heart disease, as these conditions have interrelated risk factors. Notably, both conditions can be caused by diabetes and high blood pressure - two illnesses that can damage the kidneys and blood vessels over time.
Digoxin has been used for more than 200 years to treat heart disease. But little research has explored whether it's safe for people who are also having dialysis for kidney failure. In theory, dialysis might lead to a toxic amount of digoxin in the blood. This is because dialysis causes a drop in the blood's supply of potassium, and too little potassium is known to boost digoxin concentrations. If your level of digoxin becomes too high, it can cause serious side effects, including abnormal heart rhythms, which can sometimes be fatal.
To learn more about these possible risks, US researchers have now followed more than 120,000 dialysis patients for up to four years, tracking whether they took digoxin, and whether they died during this period.
Dialysis patients taking digoxin were 28 percent more likely to have died during the study than those not taking the drug. And among those taking digoxin, the risk of dying was greater for those who had higher levels of the drug in their blood and lower levels of potassium. This supports the theory that dialysis may dangerously boost digoxin concentrations by lowering potassium levels. However, this is still just a theory.
How reliable are the findings?
This study was carefully done. To arrive at these findings, the researchers took into account several factors that might have increased people's chance of dying during the study, such as their age, whether they had other health conditions, the severity of their heart disease, and what other medicines they were taking. This boosts the reliability of their findings.
However, the researchers still can't be certain that digoxin, and not other factors, increased people's risk of dying. For example, it's possible that people prescribed digoxin were more seriously ill in ways that the researchers didn't take into account.
The study was conducted by US researchers with Fresenius Medical Care in Waltham, Massachusetts. The research was published in the Journal of the American Society of Nephrology.
If you are having dialysis and take digoxin, this study suggests you may be at risk of dying earlier than someone not taking the drug. However, we can't yet be sure of these findings. We need more research to know whether digoxin can be harmful for people having dialysis and, if so, at what doses.
Until we know more, the researchers suggest that doctors closely monitor the blood levels of digoxin and potassium in their dialysis patients who take digoxin. This can help doctors minimise any possible harmful effects from the drug. The researchers also suggest doctors consider prescribing drugs other than digoxin when suitable alternatives are available.
Talk to your doctor if you're concerned about the possible risks of taking digoxin while having dialysis. And make sure you don't stop taking digoxin unless you're advised to do so by your doctor, as this could adversely affect your heart disease.
From:
Chan KE, Lazarus JM, Hakim RM. Digoxin associates with mortality in ESRD. Journal of the American Society of Nephrology. 2010. doi: 10.1681/ASN.2009101047.
SOURCE: guardian
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