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Abstract: PO0852

Respiratory Fluoroquinolones and the Risk of Sudden Cardiac Death Among Patients Receiving Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Assimon, Magdalene M., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Pun, Patrick H., Duke University, Durham, North Carolina, United States
  • Wang, Lily, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Al-Khatib, Sana, Duke University, Durham, North Carolina, United States
  • Brookhart, M. Alan, Duke University, Durham, North Carolina, United States
  • Weber, David, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Flythe, Jennifer E., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background

Respiratory fluoroquinolones are one of the most common classes of medications with QT prolonging potential prescribed to patients receiving hemodialysis. Some studies in the general population have linked their use to sudden cardiac death (SCD). However, evidence linking respiratory fluoroquinolones to adverse cardiac outcomes in dialysis patients, a population with an exceptionally high baseline risk of SCD, is limited to case reports of torsades de pointes.

Methods

Data were obtained from a cohort of Medicare-enrolled hemodialysis patients in the U.S. Renal Data System registry (2007–2016). Using a new-user design, we conducted a retrospective cohort study to assess the comparative 5-day risk of SCD between hemodialysis patients initiating a respiratory fluoroquinolone (levofloxacin or moxifloxacin) vs. an amoxicillin-based antibiotic (amoxicillin or amoxicillin/clavulanic acid). We used an intention-to-treat analytic approach and propensity score weighted survival models, adjusting for numerous demographic and clinical covariates, to estimate weighted hazard ratios (HRs) and their 95% confidence intervals (CIs). Non-SCD was treated as a competing event.

Results

The study cohort included 264,968 unique hemodialysis patients and 626,322 study antibiotic treatment episodes: 251,726 (40.2%) respiratory fluoroquinolone treatment episodes and 374,596 (59.8%) amoxicillin-based antibiotic treatment episodes. Respiratory fluoroquinolone vs. amoxicillin-based antibiotic treatment was associated with a higher 5-day risk of SCD, weighted HR (95% CI) = 1.95 (1.57, 2.41). The association was more pronounced among individuals concurrently taking other QT prolonging medications, weighted HR (95% CI) = 2.50 (1.61, 3.88). Sensitivity analyses 1) using longer follow-up durations and 2) evaluating a composite outcome of SCD or new-onset ventricular arrhythmia yielded similar results.

Conclusion

Respiratory fluoroquinolone (vs. amoxicillin-based antibiotic) treatment was associated with an increased risk of SCD. Future research is needed to determine optimal strategies for cardiac monitoring when these medications are prescribed to patients receiving hemodialysis.

Funding

  • NIDDK Support