Use of QT Prolonging Medications by Hemodialysis Patients and Individuals Without End‐Stage Kidney Disease

Figures

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  Figure 1. Use of ≥1 prescription QT prolonging medication by the hemodialysis and non‐ESKD populations, 2012 to 2016. A and B, Depict annual standardized rates of exposure to ≥1 QT prolonging medication in the younger hemodialysis and non‐ESKD populations, respectively. C and D, Depict analogous annual rates of QT prolonging medication exposure in the older hemodialysis and non‐ESKD populations. CredibleMeds classifies medications that can prolong the QT interval as having a known, possible, or conditional TdP risk. Corresponding definitions are provided in Table 1 and lists of medications falling into each category are provided in Table S3. Medications classified as having any TdP risk are those falling into any of the 3 CredibleMeds categories. ESKD indicates end‐stage kidney disease; and TdP, torsades de pointes.

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  Figure 2. Use of ≥1 prescription medication with known TdP risk by hemodialysis patients with and without risk factors for drug‐induced QT prolongation in 2016. A, Depicts standardized rates of exposure to ≥1 medication with known TdP risk by hemodialysis patients with and without risk factors for drug‐induced QT prolongation. B, Depicts analogous rates of exposure to ≥1 non‐antiarrhythmic medication with known TdP risk in each subgroup. Medications with known TdP risk are listed in Table S3. Advanced age was defined as ≥65 years of age.9 TdP indicates torsades de pointes.

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  Figure 3. Concurrent use of medications with known TdP risk by the 2016 hemodialysis population. Values presented are crude rates of exposure to a given medication combination expressed as the number of days exposed per person‐year. TdP indicates torsades de pointes.

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  Figure 4. Concurrent use of CYP metabolized medications with known risk TdP risk and relevant metabolic inhibitors by the 2016 hemodialysis population. Values presented are crude rates of exposure to a given medication combination expressed as the number of days exposed per person‐year. Of the top 5 medications with a known TdP risk used by the adult hemodialysis population, amiodarone, citalopram, escitalopram, and ondansetron are major substrates of cytochrome isoenzymes. An “X” on the figure indicates that the QT prolonging medication is not a major substrate of specified CYP isoenzyme. Relevant CYP inhibitors are listed in Table S4. CYP indicates cytochrome P450; and TdP, torsades de pointes.