.jpg "Erica Allen, PharmD photo")
Erica Allen, PharmD
PGY2 Critical Care Pharmacy Resident
Froedtert and the Medical College of Wisconsin Froedtert Hospital
Milwaukee, Wisconsin
Disclosure information not submitted.
.jpg "Joel Feih, PharmD, BCCCP photo")
Joel Feih, PharmD, BCCCP
Critical Care Pharmacist
Froedtert and the Medical College of Wisconsin Froedtert Hospital
Milwaukee, Wisconsin, United States
Disclosure information not submitted.
Janelle Juul, PharmD, BCCCP
Critical Care Pharmacist
Froedtert and the Medical College of Wisconsin Froedtert Hospital, United States
Disclosure information not submitted.
Kaitlin Cooper-Johnson, PharmD, BCCCP
Critical Care Pharmacist
Froedtert and the Medical College of Wisconsin Froedtert Hospital, United States
Disclosure information not submitted.
David Herrmann, PharmD, BCCCP
Pharmacist
Froedtert & the Medical College of Wisconsin, United States
Disclosure information not submitted.
Adam Biggs, PharmD, BCCCP
Pharmacist, Center for Medication Utilization
Froedtert and the Medical College of Wisconsin Froedtert Hospital, United States
Disclosure information not submitted.
Title: Assessing Digoxin Dosing in Patients Undergoing Continuous Venovenous Hemofiltration
INTRODUCTION/HYPOTHESIS:
Digoxin is commonly used in hemodynamically unstable patients with heart failure or atrial fibrillation in the intensive care unit (ICU). Due to the primary renal elimination of digoxin, adjustments to typical digoxin dosing are required in renal insufficiency. However, there is limited data to guide dosing of digoxin in patients requiring continuous venovenous hemofiltration (CVVH). The purpose of this study was to evaluate the dosing of digoxin and subsequent serum concentrations in patients with varying dosing regimens and CVVH rates.
Methods:
This was a single center, retrospective cohort study of patients admitted to the ICU between August 1, 2012 and April 30, 2021 receiving concomitant digoxin and CVVH. Patients met inclusion criteria if they received digoxin and obtained a measured concentration while on CVVH. The primary endpoint was to investigate steady-state digoxin concentrations based on CVVH rate and digoxin dosing. A stepwise multiple linear regression was performed to determine the impact of the daily maintenance digoxin dose, CVVH rate, and loading dose on subsequent steady-state concentrations.
Results:
Thirty-four patients were included in this study, with a mean age of 62.6 years old and median weight of 90.7 kg. Nineteen out of the 34 patients had steady-state concentrations obtained, with a median concentration of 1 ng/mL, median daily digoxin dose of 62.5 mcg, and median CVVH rate of 2 L/hr. Thirteen patients had post-load concentrations obtained, with a median concentration of 0.85 ng/mL and median loading dose of 7.02 mcg/kg. The daily digoxin dose, CVVH rate, and loading dose were found to be statistically significantly associated with resultant steady-state concentrations (p < 0.05). The model had an R2 of 62.8% and found that the daily digoxin dose had the most significant impact on the steady-state concentrations.
Conclusions:
Daily digoxin dose, CVVH rate, and loading dose are highly associated with resultant steady-state digoxin concentrations. However, the variables in this model only accounted for 62.8% of what affected the steady-state digoxin concentrations. Future studies are needed to identify other variables that impact digoxin steady-state concentrations while on CVVH therapy.