Summary
Digitoxin is considered a risk factor for ventricular arrhythmias in hemodialysis patients. In a randomized, crossover controlled study, 55 hemodialysis outpatients with sinus rhythm were prospectively investigated in two 48-h periods of electrocardiographic monitoring, one on and one off digitoxin or vice versa. The frequency of ventricular ectopic beats (mean±SD) which were found in 31 of 55 patients (56%), was slightly higher on hemodialysis (10±28 beats/h) than in the following 20 h (5.4±10 beats/h) and the next day off hemodialysis (3.6±6.6 beats/h); however, no difference was seen in patients on digitoxin during hemodialysis (10±29 beats/h), in the following 20 h (4.8±15 beats/h) and on the next day off hemodialysis (1.2±6.6 beats/h). The frequency of ventricular bigemini, polymorphous ectopies, couplets, more than 30 ectopies/h, salvos and tachycardias (10 vs 9 patients) on and off digitoxin was about the same (n.s., Fisher test). Supraventricular bigemini, salvos, tachycardias, and atrial fibrillation, however, occurred in significantly fewer patients on digitoxin (3 vs 13) than in those off digitoxin (P=0.01, Fisher test). It is concluded that digitoxin does not increase the risk of ventricular arrhythmias in hemodialysis patients. Digitoxin, however, may have a beneficial effect on the supraventricular arrhythmias frequently observed in these patients.
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Anderson RJ, Melikian DM, Gambertoglio JG, Berns AS, Cadnapaphornchai P, Egan DJ, Goldberg JP, Heinrich WL, Hicks DL, Kovalchik MT, Olin DB (1982) Prescribing medication in long-term dialysis units. Arch Intern Med 142:1305–1308
Andresen D, Leitner ER von, Wegscheider K, Schroeder R (1982) Nachweis komplexer tachykarder ventrikulärer Rhythmusstörungen im Langzeit-EKG. Dtsch Med Wochenschr 107:571–574
Blumberg A, Haeusermann M, Strub B, Jenzer HR (1983) Cardiac arrhythmias in patients on maintenance hemodialysis. Nephron 33:91–95
Heinrich WL, Hunt JM, Nixon JV (1984) Increased ionized calcium and left ventricular contractility during hemodialysis. N Engl J Med 310:19–23
Hung JP, Harris J, Uren RF, Tiller DJ, Kelley DT (1980) Uremic cardiomyopathy — effect of hemodialysis on left ventricular function in end-stage renal failure. N Engl J Med 302:547–560
Keller F, Schwarz A, Offermann G, Molzahn M, Distler A, Kreutz G, Weinmann J, Leitner ER von, Voehringer HF (1984) Digitalis-Auslaßversuch bei Hämodialyse-Patienten. Dtsch Med Wochenschr 109:290–294
Kramer P, Köthe E, Saul J, Scheler F (1974) Uraemic and normal plasma protein binding of various cardiac-glycosides under “in vivo” conditions. Europ J Clin Invest 4:53–58
Kramer P, Girndt J, Eisenhauer T, Bethge KP, Wigger W, Valentin R (1984) Behandlung kardiovaskulärer Erkrankungen bei Dialysepatienten. Nieren Hochdruckkr 13:271–295
Kyriakidis M, Voudiclaris S, Kremastinos D, Robinson-Kyriakidis C, Vyssoulis G, Zervakis D, Toutouzas P, Komninos Z, Avgoustakis D (1984) Cardiac arrhythmias in chronic renal failure? Holter monitoring during dialysis and everyday activity at home. Nephron 38:26–29
Leitner ER von, Tietze U, Andresen D, Schroeder R (1981) Rechenkompatibles Langzeit-EKG Analysegerät zur quantitativen Erfassung einfacher und komplexer Rhythmusstörungen; Systembeschreibung und Untersuchen der Analysegenauigkeit. Z Kardiol 70:22–29
Leitner ER von, Schroeder R (1983) Das Langzeit-EKG bei Herzgesunden. Dtsch Med Wochenschr 108:523–526
Meinertz T, Kasper W, Schmitt B, Treese N, Rueckel A, Zehender M, Hofmann T, Schuster HP, Pop T (1983) Herzrhythmusstörungen bei Herzgesunden. Dtsch Med Wochenschr 108:527–531
Morrison G, Michelson EL, Brown S, Morganroth J (1980) Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients. Kidney Int 17:811–819
Quereda C, Orte L, Martesanz R, Ortuna J (1986) Ventricular ectopic activity in hemodialysis. Nephron 42:181–182
Ramirez G, Brueggemeyer CD, Newton JL (1984) Cardiac arrhythmias on hemodialysis in chronic renal failure patients. Nephron 36:212–218
Roark SF, McCarthy EA, Lee KL, Pritchett ELC (1986) Observations on the occurrence of atrial fibrillation in paroxysmal supraventricular tachycardia. Am J Cardiol 57:571–575
Weber H, Schwarzer C, Stummvoll HK, Joskowics G, Wolf A, Steinbach K, Kaindl F (1984) Chronic hemodialysis: high risk patients for arrhythmias? Nephron 37:180–185
Wizeman V, Kramer W, Funke T, Schuetterle G (1985) Dialysis-induced cardiac arrhythmias: fact or fiction? Nephron 39:356–360
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Keller, F., Weinmann, J., Schwarz, A. et al. Effect of digitoxin on cardiac arrhythmias in hemodialysis patients. Klin Wochenschr 65, 1081–1086 (1987). https://doi.org/10.1007/BF01736114
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DOI: https://doi.org/10.1007/BF01736114