Journal Article Annotations
2022, 3rd Quarter
Annotations by Sahil Munjal, MD
In this retrospective cohort study, risk for sudden cardiac death (SCD) was associated with higher(escitalopram/citalopram) versus lower QT-prolonging potential SSRI use among hemodialysis patients with a baseline potassium gradient ≥4 mEq/l [HR 2.17 (95% CI 1.16–4.03)].
Strength and weaknesses:
Strengths include the authors’ use of a large linked dataset with detailed administrative claims and clinical information including relevant biochemical indexes and dialysis treatment parameters. Particular limitations relate to the risks of residual confounding and outcome misclassification.
The study highlights drug–dialysis treatment interaction in patients prescribed citalopram/escitalopram. Dialyzing against larger serum-to-dialysate potassium gradients can result in transient intra- or postdialysis hypokalemia, which itself is a risk factor for QT prolongation. In addition to EKG monitoring in these patients, CL- psychiatrists should discuss with the nephrology team the benefits of reducing the potassium gradients <4 mEq/l by lowering predialysis serum potassium levels and/or raising dialysate potassium concentrations.