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Cystatin C vs creatinine as markers of renal function in patients on digoxin treatment

Pär Hallberg1, Håkan Melhus, Lars-Olof Hansson

  • 1Department of Medical Sciences, Clinical Chemistry and Pharmacology, University Hospital, Uppsala, Sweden.

Upsala Journal of Medical Sciences
|October 29, 2004
PubMed

Insights

Serum cystatin C better correlates with digoxin levels than serum creatinine. Improved glomerular filtration rate (GFR) monitoring using cystatin C can optimize digoxin treatment, especially in elderly patients.

Area of Science:

  • Pharmacology
  • Nephrology
  • Clinical Chemistry

Background:

  • Digoxin elimination is primarily renal, making kidney function crucial for its serum concentration.
  • Glomerular filtration rate (GFR) declines with age, impacting digoxin pharmacokinetics in the elderly.
  • Serum cystatin C is a potential alternative to creatinine for GFR estimation.

Purpose of the Study:

  • To compare the correlation between serum digoxin levels and two markers of kidney function: serum creatinine and serum cystatin C.
  • To determine which marker, creatinine or cystatin C, better reflects GFR for digoxin monitoring.

Main Methods:

  • A comparative study involving 149 patients undergoing therapeutic drug monitoring for digoxin.
  • Serum levels of digoxin, creatinine, and cystatin C were measured and compared.
  • Statistical analysis was used to assess the correlation between digoxin and the GFR markers.

Main Results:

  • Serum cystatin C showed a significantly stronger correlation with serum digoxin concentrations than serum creatinine.
  • A notable percentage of patients with elevated digoxin levels had normal serum creatinine levels, highlighting potential underestimation of impaired GFR.
  • Fewer patients with elevated digoxin levels had normal serum cystatin C levels, suggesting its superior sensitivity.

Conclusions:

  • Serum cystatin C is a more reliable marker than serum creatinine for monitoring kidney function in patients treated with digoxin.
  • Enhanced GFR monitoring, particularly with cystatin C, can lead to better control of digoxin serum concentrations.
  • Optimizing digoxin therapy through improved GFR assessment is essential, especially in aging populations.
Abstract

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