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 withdigoxin-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.
RCT Entities:
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.
Authors: Jeffrey M Testani; Brian D McCauley; Jennifer Chen; Michael Shumski; Richard P Shannon Journal: Cardiology Date: 2010-08-03 Impact factor: 1.869
Authors: J Thomas Heywood; Gregg C Fonarow; Maria Rosa Costanzo; Vandana S Mathur; John R Wigneswaran; Janet Wynne Journal: J Card Fail Date: 2007-08 Impact factor: 5.712
Authors: Jeffrey M Testani; Brian D McCauley; Jennifer Chen; Steven G Coca; Thomas P Cappola; Stephen E Kimmel Journal: J Card Fail Date: 2011-10-01 Impact factor: 5.712
Authors: Mihai Gheorghiade; Marvin A Konstam; John C Burnett; Liliana Grinfeld; Aldo P Maggioni; Karl Swedberg; James E Udelson; Faiez Zannad; Thomas Cook; John Ouyang; Christopher Zimmer; Cesare Orlandi Journal: JAMA Date: 2007-03-25 Impact factor: 56.272
Authors: Andrew S Levey; Josef Coresh; Tom Greene; Lesley A Stevens; Yaping Lucy Zhang; Stephen Hendriksen; John W Kusek; Frederick Van Lente Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: Kevin Damman; Gerjan Navis; Adriaan A Voors; Folkert W Asselbergs; Tom D J Smilde; John G F Cleland; Dirk J van Veldhuisen; Hans L Hillege Journal: J Card Fail Date: 2007-10 Impact factor: 5.712
Authors: Iris E Beldhuis; Carolyn S P Lam; Jeffrey M Testani; Adriaan A Voors; Harriette G C Van Spall; Jozine M Ter Maaten; Kevin Damman Journal: Circulation Date: 2022-02-28 Impact factor: 39.918
Authors: Meaghan Lunney; Marinella Ruospo; Patrizia Natale; Robert R Quinn; Paul E Ronksley; Ioannis Konstantinidis; Suetonia C Palmer; Marcello Tonelli; Giovanni Fm Strippoli; Pietro Ravani Journal: Cochrane Database Syst Rev Date: 2020-02-27
Authors: Ramon F Abarquez; Paul Ferdinand M Reganit; Carmen N Chungunco; Jean Alcover; Felix Eduardo R Punzalan; Eugenio B Reyes; Elleen L Cunanan Journal: ASEAN Heart J Date: 2016-03-08