Abstract: FR-PO482

The Effect of Digoxin on Renal Function in Patients with Heart Failure

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Shah, Parin M, Univerisity of Hull, Cottingham, United Kingdom
  • Bhandari, Sunil, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, East Yorkshire, Hull, United Kingdom
Background

We investigated the relation between digoxin use and change in renal function over time in patients with chronic heart failure (CHF).

Methods

1241 patients with CHF (defined as symptoms/ signs of heart failure with either reduced left ventricular ejection fraction or raised amino terminal pro B type natriuretic peptide; NTproBNP >220 ng/l) were included. The patients were divided into four groups: never on digoxin (N=394); digoxin throughout (N= 449); started digoxin at some point after baseline (N=367); and stopped digoxin at some point after baseline (N= 31). The rate of change of estimated glomerular filtration rate (eGFR) was calculated using linear regression.

Results

The average age was 72 years (64% male), and median NTproBNP 1426 ng/L (IQR 632 - 2897). Patients on digoxin throughout had a significantly greater rate of decline in eGFR per year than patients not on digoxin throughout (mean (± standard deviation); -5 (13) ml/min/1.73m2 per year v -2 (10) ml/min/1.73m2 per year, P= 0.02). In those patients who started digoxin during follow-up, there was no significant difference in the rate of decline in eGFR before and after starting digoxin. There was no correlation between baseline eGFR (or rate of decline in eGFR) and age, body mass index, haemoglobin, or NTproBNP. Patients not taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or beta blockers had a faster rate of decline in eGFR than those who were.

Conclusion

The rate of decline in renal function is greater in patients with CHF who are taking digoxin.

Correlation of eGFR with categorical variables
 Missing valuesMean Baseline eGFR (ml/min/1.73m2)P valueMissing valuesMean Rate of decline in eGFR (ml/min/1.73m2 per year)P value
Sex: male v female1958 (22)54 (19)<0.01465-2.5 (11.0)-4.3 (11.8)0.04
Sinus rhythm: yes v no3057 (22)57 (20)0.63471-2.9 (11.0)-3.4 (11.6)0.61
NYHA class: III/IV v I/II4154 (21)59 (21)<0.01471-2.6 (10.6)-4.2 (12.4)0.06
LV dysfunction: moderate/severe v normal/mild5156 (22)57 (20)0.59483-3.0 (11.2)-3.1 (11.3)0.88
ACEi /ARB: yes v no1957 (21)56 (22)0.22465-2.4 (10.8)-5.7 (12.8)0.04
BB: yes v no1958 (22)56 (20)0.18465-2.2 (10.9)-4.6 (11.8)<0.01
MRA: yes v no1958 (23)57 (20)0.30465-3.4 (13.6)-3.0 (10.3)0.66
Loop diuretic: yes v no1954 (21)64 (19)<0.01465-3.3 (11.7)-2.6 (10.1)0.44
Diabetes: yes v no1954 (21)58 (21)<0.01465-3.0 (10.5)-3.2 (11.6)0.78
Hypertension: yes v no1955 (20)58 (22)<0.01465-2.8 (10.4)-3.3 (11.8)0.51
IHD: yes v no1953 (21)60 (21)<0.01465-2.3 (10.9)-3.9 (11.6)0.05

eGFR: estimated glomerular filtration rate, NYHA: New York Heart Association, LV: left ventricular, ACEi: angiotensin-converting-enzyme inhibitor, ARB: angiotensin receptor blockers, BB: beta blocker, MRA: mineralocorticoid receptor antagonist, IHD: ischaemic heart disease.