Key result
Initiation of an SSRI with higher QT-prolonging potential (citalopram, escitalopram) was associated with a higher 1-year risk of sudden cardiac death (HR 1.18) compared to SSRIs with lower QT-prolonging potential in hemodialysis patients.
Why the study?
Patients on hemodialysis are susceptible to drug-induced QT prolongation, but the relative cardiac safety of different SSRIs in this population is unknown.
Does initiation of SSRIs with higher QT-prolonging potential increase the risk of sudden cardiac death in hemodialysis patients compared to SSRIs with lower QT-prolonging potential?
Cohort (n=65,654)
Does initiation of SSRIs with higher QT-prolonging potential increase the risk of sudden cardiac death in hemodialysis patients compared to SSRIs with lower QT-prolonging potential?
Hazard Ratio: 1.18 (95% CI 1.05–1.31)
Absolute Event Rate: 89.3% vs 68.5%
Among hemodialysis patients, initiating SSRIs with higher QT-prolonging potential (citalopram, escitalopram) is associated with a significantly increased risk of sudden cardiac death compared to SSRIs with lower QT-prolonging potential.
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May warrant preferring lower QT-prolonging SSRIs in hemodialysis; leaves open confirmation via randomized trials.
Assimon et al. (2019) conducted a cohort in End-stage renal disease on maintenance hemodialysis (n=65,654). SSRIs with higher QT-prolonging potential (citalopram, escitalopram) vs. SSRIs with lower QT-prolonging potential (fluoxetine, fluvoxamine, paroxetine, sertraline) was evaluated on 1-year sudden cardiac death (HR 1.18, 95% CI 1.05 to 1.31). Initiation of an SSRI with higher QT-prolonging potential (citalopram, escitalopram) was associated with a higher 1-year risk of sudden cardiac death (HR 1.18) compared to SSRIs with lower QT-prolonging potential in hemodialysis patients.
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