Pun reports receiving investigator-initiated research funding unrelated to this project from Medtronic; receiving honoraria from the American Society of Nephrology and the National Kidney Foundation; and receiving consulting fees from Fresenius Kidney Care, North America, AstraZeneca, Janssen, Relypsa and Ardelyx
- Azithromycin treatment correlated with a higher risk of sudden cardiac death.
- Lowering the potassium gradient could reduce the risk caused by the antibiotics.
Compared with patients on dialysis who received amoxicillin-based treatment, those who received azithromycin treatment were at an increased risk for sudden cardiac death, according to data published in Kidney Medicine.
“Recent studies among patients treated with hemodialysis have reported associations between these antibiotics and higher risks of sudden cardiac death, but the potential for intradialytic potassium shifts to augment the proarrhythmic risk of these medications has not been explored,” Patrick H. Pun, MD, MHS, from Duke University School of Medicine, and colleagues wrote. They added, “The primary objective of this study was to examine whether the serum-to-dialysate gradient modifies the cardiac safety of azithromycin, and separately, levofloxacin/moxifloxacin.”
In a retrospective observational cohort study, researchers examined data for 89,379 patients with 217,009 antibiotic treatment episodes. Patients received in-center hemodialysis and had Medicare coverage between 2007 and 2017.
With the initiation of azithromycin or amoxicillin-based antibiotics serving as the exposure and serum-to-dialysate serving as the effect modifier, researchers considered sudden cardiac death within 14 days the primary outcome of the study. Using inverse probability of treatment-weighted survival models, researchers predicted the hazard ratios.
Of the treatment episodes experienced by patients, 52.3% were azithromycin-related and 47.7% were amoxicillin-related. Compared with amoxicillin-based antibiotic treatment, azithromycin treatment correlated with a higher risk of sudden cardiac death and, according to the authors, “the risks were augmented when baseline serum-to-dialysate potassium gradients were at least 3 mEq/L.”
Pun and colleagues wrote, “Selecting antibiotics that do not prolong the QT interval when appropriate and minimizing the potassium gradient during the course of QT-prolonging antibiotic therapy may be an important steps to reducing the already high risk of sudden cardiac death borne by patients receiving maintenance hemodialysis.”