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Cystatin C may be better than creatinine for digoxin dosing in older adults with atrial fibrillation

Tomáš Šálek1,2, Martin Vodička3, Martin Gřiva4,5

  • 1Department of Clinical Biochemistry and Pharmacology, The Tomas Bata Hospital in Zlín, Zlín, Czech Republic.

Journal of Clinical Laboratory Analysis
|July 28, 2020
PubMed

Insights

Estimated glomerular filtration rate from serum cystatin C (eGFRcys) is lower than eGFRcrea in older adults with atrial fibrillation, suggesting it may help prevent digoxin overdose by enabling lower drug doses.

Area of Science:

  • Geriatric Medicine
  • Cardiology
  • Nephrology

Background:

  • Older adults on digoxin often have low muscle mass.
  • Current digoxin dosing relies on estimated glomerular filtration rate from serum creatinine (eGFRcrea).
  • This study investigates digoxin overdose in older adults with atrial fibrillation (AF).

Purpose of the Study:

  • Compare eGFRcrea and eGFRcys in older adult AF patients.
  • Assess the utility of eGFRcys in preventing digoxin overdose.
  • Evaluate GFR estimation methods for digoxin dosing.

Main Methods:

  • Prospective observational study of 80 digoxin-overdosed patients and 33 controls with AF.
  • Participants had a median age of 81 years.
  • eGFR calculated using CKD-EPI equations for serum creatinine and cystatin C.

Main Results:

  • eGFRcrea was significantly higher than eGFRcys in both overdosed and control groups.
  • In overdosed patients, median eGFRcrea was 45 vs 30 mL/min/1.73 m² for eGFRcys (P < .0001).
  • Serum predose digoxin concentration inversely correlated with eGFRcys (ρ = -0.26, P < .05).

Conclusions:

  • eGFRcys is consistently lower than eGFRcrea in older AF patients.
  • Lower eGFRcys values may guide lower digoxin doses, preventing overdose.
  • Physicians should consider GFR estimation methods beyond eGFRcrea for digoxin management.
Abstract

Keywords:
atrial fibrillationcreatininecystatin Cdigoxinestimated glomerular filtration rateglomerular filtration

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