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Potential effects of digoxin on long-term renal and clinical outcomes in chronic heart failure.
Pubmed ID: 23663810
Pubmed Central ID: PMC3694335
Journal: Journal of cardiac failure
Publication Date: May 1, 2013
Affiliation: Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA. jeffrey.testani@yale.edu
MeSH Terms: Humans, Male, Female, Middle Aged, Heart Failure, Hospitalization, Creatinine, Cardiotonic Agents, Glomerular Filtration Rate, Digoxin, Cardio-Renal Syndrome
Grants: T32 HL007843, K23 HL114868
Authors: Testani JM, Kimmel SE, Coca SG, Brisco MA, Tang WH, Tiku-Owens A, Forfia PR
Cite As: Testani JM, Brisco MA, Tang WH, Kimmel SE, Tiku-Owens A, Forfia PR, Coca SG. Potential effects of digoxin on long-term renal and clinical outcomes in chronic heart failure. J Card Fail 2013 May;19(5):295-302.
Studies:
Abstract
BACKGROUND: Digitalis glycosides are known to improve the hemodynamic and neurohormonal perturbations that contribute to heart failure (HF)-induced renal dysfunction (RD). The objective of this study was to determine if randomization to digoxin is associated with improvement in renal function (IRF) and to evaluate if patients with digoxin-induced IRF have improved clinical outcomes. METHODS AND RESULTS: Patients in the Digitalis Investigation Group (DIG) dataset with protocol-driven 1-year serum creatinine levels (performed in a central laboratory; n = 980) were studied. IRF was defined as a postrandomization ≥20% increase in estimated glomerular filtration rate (eGFR). IRF occurred in 15.5% of the population (mean improvement in eGFR 34.5 ± 15.4%) and was more common in patients randomized to digoxin (adjusted odds ratio 1.6; P = .02). In patients without IRF, digoxin was not associated with reduced death or hospitalization (adjusted hazard ratio [HR] 0.96, 95% CI 0.8-1.2; P = .67). However, in the group with IRF, digoxin was associated with substantially improved hospitalization-free survival (adjusted HR 0.49, 95% CI 0.3-0.8; P = .006; P interaction = .026). CONCLUSIONS: In this subset of the DIG trial, digoxin was associated with long-term improvement in kidney function and, in patients demonstrating this favorable renal response, reduction in death or hospitalization. Additional research is necessary to confirm these hypothesis-generating findings.