Serum digoxin levels in chronic renal failure

S. Mehmet KAYACAN,Aydın TÜRKMEN,Nazmiye ÖZBİLGİN,Tevfik ECDER,Nilgün AYSUNA,Ergin ARK

Abstract

The interpretation of serum digoxin level in chronic renal failure could be difficult due to endogeneous digoxin like substances. The aim of this study was to determine the effect of different stages of renal failure on serum digoxin levels. Sixty-one patients with chronic renal failure were included in the study and were separated into two groups (Group I: patients on digoxin therapy, Group II: patients without digoxin therapy). Each group was further divided into three subgroups depending on the patients' creatinine clearances (a: >50, b: 10-50, c: <10 cm3/min). Five of the patients in group Ic and eight of the patients in group IIc were treated with hemodialysis. Patients with same creatinine clearance either on digoxin therapy or not were matched and evaluated accordingly. Serum digoxin levels of all patients were measured by ELISA chemiluminesance method. Serum digoxin levels of patients in groups la and Ib were significantly higher than that of groups lia and lib (p<0.001), while there was a significant (p<0.05) but weak correlation between groups Ic and lie. Interestingly, digoxin was determined in the serums of all the patients withoutdigoxin therapy. Among patients without digoxin therapy, serum digoxin levels were significantly higher in the group with creatinine clearance >10 cm3/min than the group with creatinine clearance <10 cm3/min. As a result, while evaluating serum digoxin levels of patients with chronic renal failure, one should keep endogenous digoxin like factors in mind and beware of the faulty, results due to these factors especially in the predialysis stage.

Özet

Kronik böbrek yetersizliği olgularında digital benzeri maddeler nedeni ile serum digoksin düzeyi değerlendirilmeleri sıklıkla güçlüklere yol açabilmektedir. Bu çalışmada değişik derecelerdeki renal fonksiyon bozukluğunun serum digoksin düzeylerine olan etkilerinin incelenmesi amaçlanmıştır. Kronik böbrek yetersizlikli 61 hasta digital, alan (Grup I) ve almayan (Grup II) olarak ikiye, her iki grup da kreatinin klirenslerine göre (>50, 10-50, 10 cm3/dk olan Grup la ve Ib'deki hastaların serum digoksin düzeyleri Grup Ia ye Ilb'deki hastalara göre anlamlı olarak fazla (p 10 cm3/dk olan grupta <10 cm3/dk olan gruba göre anlamlı (p<0.001) olarak yüksek bulunmuştur. Sonuç olarak, serum digoksin düzeylerinin değerlendirildiği kronik böbrek yetersizlikli hastalarda endojen digoksin benzeri maddelerin var olabileceğinin unutulmaması gerektiği ve özellikle diyaliz öncesi dönemde bu endojen maddelerin hatalı sonuçlara yol açabileceği kanısına varılmıştır.