Continuous venovenous hemodialysis may be effective in digoxin removal in digoxin toxicity: A case report

Area of Science:

• Nephrology
• Cardiology
• Clinical Pharmacology

Background:

• Digoxin is a crucial medication for heart failure and atrial fibrillation, but its toxicity poses a significant risk, affecting approximately 1% of patients.
• Standard treatments for digoxin toxicity include drug cessation, electrolyte management, rhythm control, and digoxin-specific antibody fragments (Fab).
• Conventional dialysis methods like hemodialysis and peritoneal dialysis are generally ineffective for digoxin removal.

Observation:

• A 66-year-old patient presented with severe acute kidney injury and digoxin toxicity.
• The patient received continuous venovenous hemodialysis (CVVHHD) due to hypervolemia, hyperkalemia, cardiac instability, and the potential for digoxin level reduction.
• This intervention was initiated without the administration of digoxin-Fab antibodies.

Findings:

• Continuous venovenous hemodialysis successfully decreased the patient's digoxin levels.
• The patient's clinical status improved, demonstrating the efficacy of CVVHHD in managing digoxin toxicity.
• This case challenges the conventional understanding of dialysis ineffectiveness for digoxin removal.

Implications:

• Continuous venovenous hemodialysis may serve as a viable alternative treatment for digoxin toxicity, particularly in patients with severe renal dysfunction.
• This approach is especially relevant when access to digoxin-specific Fab antibodies is limited.
• Further research is warranted to explore the role and optimal parameters of CVVHHD in digoxin toxicity management.