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Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation

BACKGROUND: Patients taking digoxin are older with high probability of having low muscle mass, and current clinical practice in digoxin dosing relies only on estimated glomerular filtration rate from serum creatinine (eGFRcrea). The aim of the study is to compare eGFRcrea and estimated glomerular fi...

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Autores principales: Šálek, Tomáš, Vodička, Martin, Gřiva, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595907/
https://www.ncbi.nlm.nih.gov/pubmed/32716587
http://dx.doi.org/10.1002/jcla.23427
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author Šálek, Tomáš
Vodička, Martin
Gřiva, Martin
author_facet Šálek, Tomáš
Vodička, Martin
Gřiva, Martin
author_sort Šálek, Tomáš
collection PubMed
description BACKGROUND: Patients taking digoxin are older with high probability of having low muscle mass, and current clinical practice in digoxin dosing relies only on estimated glomerular filtration rate from serum creatinine (eGFRcrea). The aim of the study is to compare eGFRcrea and estimated glomerular filtration rate from serum cystatin C (eGFRcys) in older adult patients with atrial fibrillation (AF) overdosed with digoxin. METHODS: A total of 80 consecutive patients overdosed with digoxin and 33 controls with AF from Department of Internal Medicine were included in the prospective observational study. The median of age of participants was 81 years in both the overdosed and the control group. The eGFRs were calculated using The Chronic Kidney Disease Epidemiology (CKD‐ EPI) equations using standardized methods for serum creatinine and cystatin C measurement. RESULTS: The median (IQR) of eGFRcrea was higher than that of eGFRcys (45 mL/min/1.73 m(2) (35‐59) vs 30 (21‐38), respectively; P < .0001) in overdosed patients. The median (IQR) of eGFRcrea was higher than that of eGFRcys (61 mL/min/1.73 m(2) (49‐72) vs 40 (30‐56), respectively; P < .0001) in control group of patients. Serum predose digoxin concentration in overdosed patients was inversely associated with eGFRcys (ρ = −0.26, P < .05). CONCLUSION: Physicians should consider GFR when changing digoxin dosing. eGFRcys was lower in both the overdosed and the control group. eGFRcys would lead to lower digoxin doses and thus prevent overdose.
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spelling pubmed-75959072020-11-02 Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation Šálek, Tomáš Vodička, Martin Gřiva, Martin J Clin Lab Anal Research Articles BACKGROUND: Patients taking digoxin are older with high probability of having low muscle mass, and current clinical practice in digoxin dosing relies only on estimated glomerular filtration rate from serum creatinine (eGFRcrea). The aim of the study is to compare eGFRcrea and estimated glomerular filtration rate from serum cystatin C (eGFRcys) in older adult patients with atrial fibrillation (AF) overdosed with digoxin. METHODS: A total of 80 consecutive patients overdosed with digoxin and 33 controls with AF from Department of Internal Medicine were included in the prospective observational study. The median of age of participants was 81 years in both the overdosed and the control group. The eGFRs were calculated using The Chronic Kidney Disease Epidemiology (CKD‐ EPI) equations using standardized methods for serum creatinine and cystatin C measurement. RESULTS: The median (IQR) of eGFRcrea was higher than that of eGFRcys (45 mL/min/1.73 m(2) (35‐59) vs 30 (21‐38), respectively; P < .0001) in overdosed patients. The median (IQR) of eGFRcrea was higher than that of eGFRcys (61 mL/min/1.73 m(2) (49‐72) vs 40 (30‐56), respectively; P < .0001) in control group of patients. Serum predose digoxin concentration in overdosed patients was inversely associated with eGFRcys (ρ = −0.26, P < .05). CONCLUSION: Physicians should consider GFR when changing digoxin dosing. eGFRcys was lower in both the overdosed and the control group. eGFRcys would lead to lower digoxin doses and thus prevent overdose. John Wiley and Sons Inc. 2020-06-17 /pmc/articles/PMC7595907/ /pubmed/32716587 http://dx.doi.org/10.1002/jcla.23427 Text en © 2020 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Research Articles
Šálek, Tomáš
Vodička, Martin
Gřiva, Martin
Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
title Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
title_full Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
title_fullStr Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
title_full_unstemmed Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
title_short Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
title_sort cystatin c may be better than creatinine for digoxin dosing in older adults with atrial fibrillation
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595907/
https://www.ncbi.nlm.nih.gov/pubmed/32716587
http://dx.doi.org/10.1002/jcla.23427
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