Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Milrinone - phosphodiesterase-3 inhibitor - commonly used for the treatment of low-cardiac-output states such as cardiogenic shock. As milrinone is predominantly excreted unchanged into the urine, it carries the risk of accumulation and increased plasma concentrations in the setting of impaired renal function. This can potentially increase the risk of significant adverse effects including cardiac arrhythmias and hypotension. Despite these concerns, studies that evaluate the dose-response relationship between new-onset arrhythmias and renal impairment are scarce. The purpose of this study is to evaluate the association of new-onset arrhythmias from milrinone in patients with renal impairment compared to patients without renal impairment.
Methods: This is a retrospective study of adult patients admitted at Texas Health Presbyterian Hospital Dallas who received a weight-based dose of milrinone for at least 12 hours. Patients were excluded if they received antiarrhythmic agents while hospitalized prior to receiving milrinone, received dobutamine within 1 hour prior to initiating milrinone, or received concurrent dobutamine and milrinone infusions. The primary outcome was new-onset cardiac arrhythmias after the initial administration of a weight-based continuous intravenous infusion of milrinone. The secondary outcomes included time to first new arrhythmia from milrinone initiation, milrinone infusion rate at arrhythmia, and incidence of hypotension.
Results: A preliminary analysis of 107 patients was performed (51 patients in the no renal impairment group and 56 patients in the renal impairment group). New-onset cardiac arrhythmias occurred in 22 (43.1%) patients without renal impairment and 28 (50%) patients with renal impairment (p = 0.477). The mean time to first new arrhythmia was 20.6 hours and 19.9 hours in the renal impairment group and the group without renal impairment group, respectively (p = 0.427). Hypotension occurred in 43.94% of patients without renal impairment and 56% in patients with renal impairment (p = 0.328).
Conclusions: Based on the data from this study, there was no association of new-onset arrhythmias between milrinone and renal impairment.
