ArticleKidney international2022
Azithromycin use increases the risk of sudden cardiac death in patients with hemodialysis-dependent kidney failure.
Article in Kidney international, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 14 citations in OpenAlex.
- Recognizing the Elephant in the Room: High Arrhythmia Risk in Hemodialysis Patients' Prescriptions.Cureus · 2026Article
- QT-prolonging medications: prevalence of use and associated risks in CKD.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Review
- Comparative cardiac safety of haloperidol vs. chlorpromazine among people receiving hemodialysis.Journal of psychiatric research · 2025Article
- Distinguishing Among Causes of Death for Patients with Kidney Failure on Hemodialysis.Kidney360 · 2025Article
- Cardiovascular benefits and safety profile of macrolide maintenance therapy in patients with bronchiectasis.The European respiratory journal · 2025Article
- Prescription and Dispensation of QT-Prolonging Medications in Individuals Receiving Hemodialysis.JAMA network open · 2024Article
- QT-Prolonging Antibiotics, Serum-to-Dialysate Potassium Gradient, and Risk of Sudden Cardiac Death Among Patients Receiving Maintenance Hemodialysis.Kidney medicine · 2023Article
- Individualization of Serum-to-Dialysate Potassium Concentrations to Reduce the Risk of Sudden Cardiac Death Conferred by QT-Prolonging Antibiotics in Patients Receiving Hemodialysis.Kidney medicine · 2023Article
- letter to the editor.Kidney international · 2022Article
- Infection indication and severity.Kidney international · 2022Article
- Atypical Antipsychotics and the Risk of Sudden Cardiac Death among Individuals Receiving Maintenance Hemodialysis.General hospital psychiatryArticle
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8 authors at 4 institutions in 1 country.
Funding
Abstract
Azithromycin is an antibiotic with QT-prolonging potential commonly prescribed to individuals receiving hemodialysis. Hemodialysis patients have a high prevalence of clinical conditions, such as structural heart disease, that can enhance the pro-arrhythmic effects azithromycin, but were excluded from prior investigations evaluating the cardiac safety of azithromycin. Using data from the United States Renal Data System (2007-2017), we conducted two cohort studies to examine the cardiac safety of azithromycin relative to amoxicillin-based antibiotics (amoxicillin, amoxicillin/clavulanic acid) and levofloxacin (a fluoroquinolone antibiotic known to prolong the QT-interval) in the hemodialysis population. The primary outcome was five-day sudden cardiac death. Using inverse probability of treatment weighted survival models, we estimated hazard ratios, risk differences, and 95% confidence intervals. The azithromycin vs. amoxicillin-based antibiotic cohort included 282,899 patients and 725,431 treatment episodes (381,306 azithromycin and 344,125 amoxicillin-based episodes). Azithromycin vs. amoxicillin-based antibiotic treatment was associated with higher relative and absolute risks of sudden cardiac death, weighted hazard ratio of 1.70 (95% Confidence Interval, 1.36 to 2.11) and weighted risk difference per 100,000 treatment episodes of 25.0 (15.5 to 36.5). The azithromycin vs. levofloxacin cohort included 245,143 patients and 554,557 treatment episodes (387,382 azithromycin and 167,175 levofloxacin episodes). Azithromycin vs. levofloxacin treatment was associated with lower relative and absolute risks of sudden cardiac death, weighted hazard ratio of 0.79 (0.64 to 0.96) and weighted risk difference per 100,000 treatment episodes of -18.9 (-35.5 to -3.8). Thus, when selecting among azithromycin, levofloxacin, and amoxicillin-based antibiotics, clinicians should weigh the relative antimicrobial benefits of these drugs against their potential cardiac risks.
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