Martin-Suarez Ana, García González David, Macías Núñez Juan F, Ardanuy Albajar Ramón, Calvo Hernández M Victoria
Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.
Instituto de Investigación Biomédica de Salamanca, University Hospital of Salamanca, Salamanca, Spain.
Drugs Aging. 2016 Apr;33(4):277-84. doi: 10.1007/s40266-016-0346-5.
Digoxin is a frequently prescribed drug in the elderly population. Estimated glomerular filtration rate is widely used to adjust dosages. The HUGE value is a tool for differentiating the presence or absence of chronic kidney disease in elderly patients. We aimed to investigate the usefulness of the HUGE value to predict the initial dose of digoxin in patients aged older than 70 years.
We reviewed retrospectively the medical records of patients aged older than 70 years with serum digoxin concentrations (SDCs) monitored over a 6-month period (63 patients). A linear regression relating the patient's SDC, maintenance dose of digoxin and the HUGE value was estimated to generate a dosage equation. This equation was validated retrospectively (33 patients) and prospectively (35 patients) in comparison with two existing methods based on creatinine clearance.
An equation (HUGE_DIG) was generated to calculate the initial digoxin dose to reach a specific target SDC. Thus, to achieve a SDC of 0.8 ng/mL: Digoxin (mg/day) = 0.091 - 0.006 x HUGE. After retrospective validation, the calculated digoxin doses with this equation were administered in the prospective phase and we did not observe statistical differences between measured and desired SDCs. Moreover, the predictive performance of our equation was better than that obtained with the compared methods.
We offer a new validated digoxin dosing equation for elderly patients. Our results support the need to perform digoxin dosing in elderly people, bearing in mind the changes in renal physiology secondary to ageing and not merely the estimated glomerular filtration rate.
地高辛是老年人群中常用的药物。估算肾小球滤过率被广泛用于调整剂量。HUGE值是区分老年患者是否存在慢性肾病的一种工具。我们旨在研究HUGE值对预测70岁以上患者地高辛初始剂量的有效性。
我们回顾性分析了6个月内监测血清地高辛浓度（SDC）的70岁以上患者的病历（63例患者）。通过估算患者的SDC、地高辛维持剂量与HUGE值之间的线性回归关系来生成剂量方程。与基于肌酐清除率的两种现有方法相比，对该方程进行回顾性验证（33例患者）和前瞻性验证（35例患者）。
生成了一个方程（HUGE_DIG）来计算达到特定目标SDC的地高辛初始剂量。因此，要达到0.8 ng/mL的SDC：地高辛（mg/天）= 0.091 - 0.006×HUGE。回顾性验证后，在前期阶段使用该方程计算的地高辛剂量进行给药，我们未观察到实测SDC与预期SDC之间存在统计学差异。此外，我们方程的预测性能优于所比较方法的预测性能。
我们为老年患者提供了一个经过验证的新的地高辛给药方程。我们的结果支持在老年患者中进行地高辛给药时，要考虑到衰老导致的肾脏生理变化，而不仅仅是估算肾小球滤过率。
