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Abstract: TH-OR093

The Comparative Cardiac Safety of Selective Serotonin Reuptake Inhibitors (SSRIs) in the Hemodialysis (HD) Population

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Assimon, Magdalene M., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
  • Flythe, Jennifer E., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
Background

HD patients may be particularly susceptible to the lethal consequences of drug-induced QT prolongation due to their tremendous cardiovascular disease burden and recurrent exposure to electrolyte shifts during HD treatments. Electrophysiologic data indicate that citalopram and escitalopram prolong the QT interval more than other SSRIs. Even though 37% of HD patients receive SSRI therapy, the relative cardiac safety of individual SSRIs in this vulnerable population is not well-established.

Methods

Data were taken from a cohort of Medicare-enrolled HD patients in the United States Renal Data System registry (2007–2014). Using a new-user design, we conducted a retrospective cohort study to assess the comparative 1-year risk of sudden cardiac death between HD patients initiating SSRIs with higher (citalopram, escitalopram) vs. lower (fluoxetine, fluvoxamine, paroxetine, sertraline) QT prolonging potential. We used propensity-score weighted survival models, adjusted for numerous demographic and clinical covariates, to estimate adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs). All analyses used an on-treatment analytic approach and treated non-sudden cardiac death as a competing event.

Results

Of 65,654 study patients, 30,932 (47.1%) started an SSRI with higher QT prolonging potential and 34,722 (52.9%) started an SSRI with lower QT prolonging potential. Initiation of an SSRI with higher (vs. lower) QT prolonging potential was associated with an increased 1-year risk of sudden cardiac death, aHR [95% CI] = 1.14 [1.05–1.25]. Observed associations were particularly elevated among females (1.21 [1.07–1.37]); individuals ≥75 years old (1.14 [1.01–1.28]); individuals with structural heart disease (1.13 [1.03–1.23]); and those concurrently using other QT prolonging medications (1.16 [1.04–1.29]). Sensitivity analyses 1) evaluating a composite outcome of sudden cardiac death or new-onset ventricular arrythmia, and 2) using an intent-to-treat analytic approach yielded similar results (not shown).

Conclusion

Initiation of an SSRI with higher (vs. lower) QT prolonging potential was associated with an increased risk of sudden cardiac death. When prescribing SSRIs to HD patients, providers should consider the QT prolonging potential of these agents, especially among individuals with sudden cardiac death risk factors.

Funding

  • NIDDK Support