Evaluating plasma Digoxin concentration after an intravenous loading dose in patients with renal failure

<p>Background: Digoxin is a medication of Glycoside family which is commonly prescribed for patients with atrial fibrillation, atrial flutter, and heart failure. With a narrow therapeuticlevel(0.5-2 ng/mL), careful monitoring of digoxin blood level is necessary. Symptoms of digoxin toxicity in...

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Główni autorzy: Vahid Eslami (Autor), Fatemeh Mortezapour (Autor), Shiva Samavat (Autor), Shadi Ziae (Autor), Azin Gheymati (Autor)
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Wydane: Archives of Clinical Nephrology - Peertechz Publications, 2021-06-04.
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001 peertech__10_17352_acn_000053
042 |a dc 
100 1 0 |a Vahid Eslami  |e author 
700 1 0 |a  Fatemeh Mortezapour  |e author 
700 1 0 |a  Shiva Samavat  |e author 
700 1 0 |a  Shadi Ziae  |e author 
700 1 0 |a Azin Gheymati  |e author 
245 0 0 |a Evaluating plasma Digoxin concentration after an intravenous loading dose in patients with renal failure 
260 |b Archives of Clinical Nephrology - Peertechz Publications,   |c 2021-06-04. 
520 |a <p>Background: Digoxin is a medication of Glycoside family which is commonly prescribed for patients with atrial fibrillation, atrial flutter, and heart failure. With a narrow therapeuticlevel(0.5-2 ng/mL), careful monitoring of digoxin blood level is necessary. Symptoms of digoxin toxicity include nausea, vomiting, visual changes, altered mental status, hyperkalemia, and cardiovascular collapse. As renal failure decreases the clearance of digoxin, and impaired renal function is common in heart failure, this population is at higher risk of toxicity. </p><p>Methods & materials: In this prospective study, patients with chronic kidney disease- nondialysis (CKD-ND) who were admitted with heart failure or atrial fibrillation at university hospital, were enrolled. Digoxin-naive patients were treated with a 10 mcg/kg intravenous digoxin loading dose. Serum digoxin level was measured 6 to 12 hours after the last loading dose. Patients were followed for 48 hours for signs of toxicity. Correlation between therapeutic digoxin level and degree of renal failure was evaluated. The effect of serum electrolyte (magnesium, calcium, and potassium) concentration on digoxin level was determined. Pregnant women were excluded from study.</p><p>Results: From 2018 to 2020, 87 CKD patients, (60 (69%) men and 27 (31%) women) aged from 31 to 92 years old, with a mean age of 70.51 ± 14.06 years were admitted to the cardiac unit. Near 80% of the cohort were CKD stage 3 and 4 patients. About half of patients had digoxin levels in therapeutic range (45 cases = 51.7%), followed by 24.1% with supra therapeutic and the other 24.1% with toxic levels. There was significant relationship between GFR and serum digoxin concentration (p-value = 0.038); the lower the GFR was, the higher was the digoxin level and also between serum creatinine and digoxin level (p value: .04). Serum digoxin concentration had significant correlation with serum magnesium level (p-value = 0.006).</p><p>Conclusion: this study demonstrated that monitoring plasma Digoxin concentration after an intravenous loading dose in patients with renal failure can be very helpful to prevent digoxin toxicity. The lower the GFR was, the higher the digoxin level and the risk for toxicity if the bolus and even maintenance do not monitor meticulously.</p> 
540 |a Copyright © Vahid Eslami et al. 
546 |a en 
655 7 |a Research Article  |2 local 
856 4 1 |u https://doi.org/10.17352/acn.000053  |z Connect to this object online.