Respiratory Fluoroquinolone May Increase the Risk of Sudden Cardiac Death Among Patients Receiving Hemodialysis

Among patients on receiving hemodialysis (HD), treatment with fluoroquinolone may be linked with an augmented risk of sudden cardiac death (SCD) when compared to treatment with an amoxicillin-based antibiotic, according to a study published in JAMA Cardiology.

“Respiratory fluoroquinolone antibiotics are some of the most common medications with QT interval–prolonging potential prescribed to patients with hemodialysis-dependent kidney failure—individuals who have a very high risk of SCD. To date, there have been no large-scale, population-specific studies evaluating the cardiac safety of respiratory fluoroquinolones in the hemodialysis population,” the researchers wrote.

Thus retrospective cohort study assessed safety via an active comparator new-user design. The researchers analyzed administrative claims data from a US-wide kidney failure registry from January 1, 2007, to December 31, 2016. In total, the study consisted of 264,968 Medicare beneficiaries receiving in-center HD. The primary endpoint was defined as sudden cardiac death within 5 days of outpatient initiation of a study antibiotic. Data analysis was conducted from January 4 to August 16, 2021.

According to the results, respiratory fluoroquinolone vs amoxicillin-based antibiotic treatment was associated with a higher relative and absolute 5-day risk of SCD (weighted HR=1.95; 95% CI, 1.57-2.41; and weighted RD per 100 000 treatment episodes, 44.0; 95% CI, 31.0-59.2). However, the researchers noted that respiratory fluoroquinolone vs amoxicillin-based antibiotic treatment was not associated with the 5-day risk of fracture.

“In this study, compared with amoxicillin-based antibiotic treatment, respiratory fluoroquinolone treatment was associated with a higher short-term risk of SCD among patients with hemodialysis-dependent kidney failure,” the researchers concluded.


“This finding suggests that decisions between the use of respiratory fluoroquinolones and amoxicillin-based antibiotics should be individualized, with prescribers considering both the clinical benefits and potential cardiac risks.”