QT-Prolonging Antibiotics, Serum-to-Dialysate Potassium Gradient, and Risk of Sudden Cardiac Death Among Patients Receiving Maintenance Hemodialysis

Ondansetron and the Risk of Sudden Cardiac Death among Individuals Receiving Maintenance Hemodialysis

“…3 Furthermore, prior pharmacoepidemiologic safety studies showed that individuals receiving hemodialysis had higher risks of sudden cardiac death and other adverse cardiac outcomes when initiating medications known to prolong the QT interval compared with initiating clinically relevant comparator medications with lesser QT-prolonging potential. [7][8][9][10][11][12] The observed association of initiation of ondansetron (versus comparator antiemetic) and 10-day risk of sudden cardiac death was similar across clinically relevant subgroups. Consistent with data from the general population, we found that patients 65 years and older (versus younger than 65 years) and patients with (versus without) heart failure seemed to have higher 10-day relative risks of sudden cardiac death with initiation of ondansetron versus a comparator antiemetic.…”

“…3 Furthermore, prior pharmacoepidemiologic safety studies showed that individuals receiving hemodialysis had higher risks of sudden cardiac death and other adverse cardiac outcomes when initiating medications known to prolong the QT interval compared with initiating clinically relevant comparator medications with lesser QT-prolonging potential. 7–12…”

“…[3][4][5][6] Existing pharmacoepidemiologic safety data show that, compared with initiation of clinically relevant comparator medications, initiation of medications known to prolong the QT interval, such as escitalopram, citalopram, azithromycin, and respiratory fluoroquinolones, is associated with a higher risk of sudden cardiac death in the hemodialysis population. [7][8][9][10][11][12] Ondansetron, a commonly prescribed antiemetic, can prolong the QT interval and has a known risk of Torsades de Pointes. 13 In 2011, the US Food and Drug Administration (FDA) issued a safety communication informing the public about the potential for abnormal heart rhythms with intravenous ondansetron.…”

“…3–6 Existing pharmacoepidemiologic safety data show that, compared with initiation of clinically relevant comparator medications, initiation of medications known to prolong the QT interval, such as escitalopram, citalopram, azithromycin, and respiratory fluoroquinolones, is associated with a higher risk of sudden cardiac death in the hemodialysis population. 7–12…”

Individualization of Serum-to-Dialysate Potassium Concentrations to Reduce the Risk of Sudden Cardiac Death Conferred by QT-Prolonging Antibiotics in Patients Receiving Hemodialysis

“…In this issue of Kidney Medicine , Pun et al 2 address 2 relevant yet underappreciated topics: the composition of the hemodialysate with its relationship to the prevailing serum potassium concentration and the use of antibiotic drugs that may prolong the QT interval. The authors shed light on the combined effects of the dialysate-to-serum potassium gradient and the antibiotic drugs on the risk of sudden cardiac death (SCD).…”