Intermittent low-dose digoxin may be effective and safe in patients with chronic heart failure undergoing maintenance hemodialysis

Abstract

A low dose of digoxin is known to reduce mortality and hospitalization in patients with heart failure; however, the safety of digoxin in treating patients with heart failure on maintenance hemodialysis remains controversial. The objective of this study was to determine the effectiveness and safety of digoxin at lower doses in patients with heart failure on maintenance hemodialysis using a retrospective cohort study. This study included 67 heart-failure patients on maintenance hemodialysis: Twenty-four patients received intermittent low doses of digoxin (ILDD), 23 patients received continuous low doses of digoxin (CLDD) and the remaining patients were used as a control group without digoxin treatment. The brain natriuretic peptide (BNP) level and serum digoxin concentrations (SDCs) were measured by ELISA and the changes in left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), cardiac output (CO) and heart rate (HR) were evaluated by two-dimensional echocardiography. The symptoms of digoxin toxicity were monitored in the treated patients. Compared with the control group, LVEDD, BNP and HR decreased significantly between days 0 and 60 in the ILDD and CLDD groups, but LVEF and CO increased between days 0 and 60 in the same groups (all P<0.05). The levels of BNP and the LVEDD, CO, LVEF and HR were not significantly different between the ILDD and CLDD groups (P>0.05). Furthermore, and the mean SDC of the ILDD group was lower than that of the CLDD group. In the ILDD group, no patients had apparent symptoms of toxicity, but four patients developed digoxin toxicity in the CLDD group. In conclusion an intermittent lower dose of digoxin has beneficial effects and clinical safety in hemodialysis patients with congestive heart failure.

Values of hemodynamic variation in response to passive leg raising in predicting exercise capacity of heart failure with preserved ejection fraction

“…According to the curvilinearity of the Frank–Starling relationship, if the heart is operating on the initial and steep part of the curve, it should have some preload reserve, and an increase in cardiac preload results in an increase in SV. [ 18 , 37 ] Previous studies of hemodynamic effects of PLR indicated that hemodynamic changes related to PLR were only induced by increased cardiac preload. [ 38 ] CO in response to PLR was according to the central volume status and the degree of cardiac preload reserve.…”

“…[ 15 – 17 ] The hemodynamic parameters CO, cardiac index (CI), stroke volume (SV), stroke volume index (SVI), left stroke work (LSW), and left stroke work index (LSWI) correlated positively with cardiac function. [ 18 ] Stroke systemic vascular resistance (SSVR) represents the resistance of blood flow in the vascular system. Stroke systemic vascular resistance index (SSVRI) is the systemic vascular resistance normalized for body surface area.…”

Association of Digoxin Application Approaches With Long-Term Clinical Outcomes in Rheumatic Heart Disease Patients With Heart Failure: A Retrospective Study

“…Ahmed et al ( 12 ) reported that a low dose (125 μg po qod) of DGX was related to lower risk of mortality and hospitalization under condition of lower serum DGX concentration (SDC). In dialysis patients with HF receiving lower-dose DGX treatment (62.5 μg po qod), patients with iDGX had fewer DGX-related poisoning symptoms and were safer compared to those with cDGX ( 13 ). These findings suggested that the DGX use in HF management may be dynamic and change with congestion status.…”

Safety of Digoxin Loading in Patients Undergoing Continuous Renal Replacement Therapy.

“…As digoxin is primarily renally excreted, recommendations regarding dosage adjustment exists for varying degrees of renal function with limited guidance for dosage adjustments in intermittent hemodialysis (iHD) [7]. However, there is scarce published data regarding digoxin dosage adjustment and monitoring for the in CRRT, mostly in the form of case reports and series [7][8][9]. The purpose of this study is to evaluate the safety of administering digoxin in patients with A b-RVR undergoing CRRT therapy and e cacy in attaining rate control.…”