{"title":"血清胱抑素 C 是心力衰竭和慢性肾病老年患者地高辛治疗浓度超标的风险因素之一","authors":"Jie-Jiu Lu, Tao-Tao Liu","doi":"10.1007/s40256-024-00629-5","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Digoxin is primarily metabolized by the kidney, and its toxicity is strongly associated with high concentrations, particularly in elderly patients. The purpose of this study was to evaluate the predictive performance of renal function biomarkers for supratherapeutic digoxin concentrations in elderly patients with heart failure (HF) and chronic kidney disease (CKD).</p><h3>Methods</h3><p>Data were retrospectively obtained from elderly patient with HF and CKD who received digoxin treatment from January 2022 and December 2022. Logistic regression was used to assess independent risk factors for supratherapeutic concentrations. The predictive performance of serum creatinine, serum cystatin C, and blood urea nitrogen on supratherapeutic concentrations was compared by receiver operating characteristic analysis.</p><h3>Results</h3><p>A total of 115 elderly patients with HF and CKD were enrolled in our study. Supratherapeutic concentrations were detected in 49 patients. Logistic regression analysis showed that estimated glomerular filtration rate calculated by serum cystatin C [eGFR<sub>CysC</sub>, odds ratio (OR): 0.962, <i>P</i> = 0.006], heart rate (OR: 1.024, <i>P</i> = 0.040), and NYHA class (OR: 3.099, <i>P</i> = 0.010) were independent risk factors for supratherapeutic concentration. Cutoff value for eGFR<sub>CysC</sub> between the two groups was 41 ml/min/1.73m<sup>2</sup>. Predictive performance of serum cystatin C was further improved in patients with obesity, CKD stage 4–5, and older than 75 years compared with normal weight, CKD stage 3, and aged 60–75-year-old patients.</p><h3>Conclusions</h3><p>Serum cystatin C is a sensitive renal function biomarker to predict supratherapeutic digoxin concentration in elderly patients with HF and CKD.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"303 - 311"},"PeriodicalIF":2.8000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Serum Cystatin C as a Risk Factor for Supratherapeutic Digoxin Concentration in Elderly Patients with Heart Failure and Chronic Kidney Disease\",\"authors\":\"Jie-Jiu Lu, Tao-Tao Liu\",\"doi\":\"10.1007/s40256-024-00629-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Digoxin is primarily metabolized by the kidney, and its toxicity is strongly associated with high concentrations, particularly in elderly patients. The purpose of this study was to evaluate the predictive performance of renal function biomarkers for supratherapeutic digoxin concentrations in elderly patients with heart failure (HF) and chronic kidney disease (CKD).</p><h3>Methods</h3><p>Data were retrospectively obtained from elderly patient with HF and CKD who received digoxin treatment from January 2022 and December 2022. Logistic regression was used to assess independent risk factors for supratherapeutic concentrations. The predictive performance of serum creatinine, serum cystatin C, and blood urea nitrogen on supratherapeutic concentrations was compared by receiver operating characteristic analysis.</p><h3>Results</h3><p>A total of 115 elderly patients with HF and CKD were enrolled in our study. Supratherapeutic concentrations were detected in 49 patients. Logistic regression analysis showed that estimated glomerular filtration rate calculated by serum cystatin C [eGFR<sub>CysC</sub>, odds ratio (OR): 0.962, <i>P</i> = 0.006], heart rate (OR: 1.024, <i>P</i> = 0.040), and NYHA class (OR: 3.099, <i>P</i> = 0.010) were independent risk factors for supratherapeutic concentration. Cutoff value for eGFR<sub>CysC</sub> between the two groups was 41 ml/min/1.73m<sup>2</sup>. Predictive performance of serum cystatin C was further improved in patients with obesity, CKD stage 4–5, and older than 75 years compared with normal weight, CKD stage 3, and aged 60–75-year-old patients.</p><h3>Conclusions</h3><p>Serum cystatin C is a sensitive renal function biomarker to predict supratherapeutic digoxin concentration in elderly patients with HF and CKD.</p></div>\",\"PeriodicalId\":7652,\"journal\":{\"name\":\"American Journal of Cardiovascular Drugs\",\"volume\":\"24 2\",\"pages\":\"303 - 311\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Cardiovascular Drugs\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://link.springer.com/article/10.1007/s40256-024-00629-5\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiovascular Drugs","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s40256-024-00629-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：地高辛主要通过肾脏代谢，其毒性与高浓度密切相关，尤其是在老年患者中。本研究旨在评估肾功能生物标志物对心力衰竭（HF）和慢性肾脏病（CKD）老年患者超治疗浓度地高辛的预测性能：方法：回顾性获取2022年1月至2022年12月期间接受地高辛治疗的HF和CKD老年患者的数据。采用逻辑回归评估超治疗浓度的独立风险因素。通过接收器操作特征分析比较了血清肌酐、血清胱抑素C和血尿素氮对超治疗浓度的预测性能：共有 115 名患有心房颤动和慢性肾脏病的老年患者参与了研究。49名患者检测到超治疗浓度。逻辑回归分析显示，以血清胱抑素 C 计算的估计肾小球滤过率[eGFRCysC，几率比（OR）：0.962，P = 0.006]、心率（OR：1.024，P = 0.040）和 NYHA 分级（OR：3.099，P = 0.010）是超治疗浓度的独立危险因素。两组 eGFRCysC 的临界值为 41 ml/min/1.73m2。与正常体重、CKD 3 期和 60-75 岁的患者相比，肥胖、CKD 4-5 期和 75 岁以上的患者血清胱抑素 C 的预测能力进一步提高：结论：血清胱抑素 C 是一种敏感的肾功能生物标志物，可用于预测高血压合并慢性肾功能衰竭老年患者的地高辛超治疗浓度。
Serum Cystatin C as a Risk Factor for Supratherapeutic Digoxin Concentration in Elderly Patients with Heart Failure and Chronic Kidney Disease
Background
Digoxin is primarily metabolized by the kidney, and its toxicity is strongly associated with high concentrations, particularly in elderly patients. The purpose of this study was to evaluate the predictive performance of renal function biomarkers for supratherapeutic digoxin concentrations in elderly patients with heart failure (HF) and chronic kidney disease (CKD).
Methods
Data were retrospectively obtained from elderly patient with HF and CKD who received digoxin treatment from January 2022 and December 2022. Logistic regression was used to assess independent risk factors for supratherapeutic concentrations. The predictive performance of serum creatinine, serum cystatin C, and blood urea nitrogen on supratherapeutic concentrations was compared by receiver operating characteristic analysis.
Results
A total of 115 elderly patients with HF and CKD were enrolled in our study. Supratherapeutic concentrations were detected in 49 patients. Logistic regression analysis showed that estimated glomerular filtration rate calculated by serum cystatin C [eGFRCysC, odds ratio (OR): 0.962, P = 0.006], heart rate (OR: 1.024, P = 0.040), and NYHA class (OR: 3.099, P = 0.010) were independent risk factors for supratherapeutic concentration. Cutoff value for eGFRCysC between the two groups was 41 ml/min/1.73m2. Predictive performance of serum cystatin C was further improved in patients with obesity, CKD stage 4–5, and older than 75 years compared with normal weight, CKD stage 3, and aged 60–75-year-old patients.
Conclusions
Serum cystatin C is a sensitive renal function biomarker to predict supratherapeutic digoxin concentration in elderly patients with HF and CKD.
期刊介绍：
Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents.
Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations.
The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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