title: Digitalis in chronic renal insufficiency.
abstract: Cardiac dysfunction is common in patients with terminal renal failure. However, no consensus has been reached with respect to the indications for digitalis therapy. Depression of myocardial contractility may occur as a result of circulating toxic factors, parathyroid hormone, and altered catecholaminergic responsiveness. On the other hand, paradoxical positive inotropic effects have been observed possibly as a result of a circulating natriuretic factor (an endogenous digitalis analogue) which inhibits Na,K-ATP'ase. Pharmacokinetics and pharmacodynamics of digitalis steroids are altered in uremia. Elimination half-lives of strophanthin and digoxin are prolonged, whereas the elimination half-life of digitoxin is unchanged. Altered protein binding and volume of distribution have been noted. Despite its long elimination half-life, most nephrologists favor administration of digitoxin because of its insensitivity to changes in renal function.
mesh_terms: D000818:Animals; D001682:Biological Availability; D001769:Blood / Q000378:metabolism; D001798:Blood Proteins / Q000502:physiology; D002298:Cardenolides; D009202:Cardiomyopathies / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D002415:Cats; D004070:Digitalis; D004074:Digitoxin / Q000378:metabolism / Q000494:pharmacology / Q000506:poisoning / Q000627:therapeutic use; D004077:Digoxin / Q000378:metabolism / Q000494:pharmacology / Q000506:poisoning / Q000627:therapeutic use; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D006168:Guinea Pigs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D007700:Kinetics; D008657:Metabolic Clearance Rate; D009200:Myocardial Contraction / Q000187:drug effects; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010946:Plants, Medicinal; D010947:Plants, Toxic; D011817:Rabbits; D011896:Rana temporaria; D051381:Rats; D006435:Renal Dialysis; D012503:Saponins; D000254:Sodium-Potassium-Exchanging ATPase / Q000037:antagonists & inhibitors; D013268:Stimulation, Chemical; D014462:Ultrafiltration; D014511:Uremia / Q000150:complications / Q000188:drug therapy / Q000201:enzymology / Q000503:physiopathology
chemical_list: D001798:Blood Proteins; D002298:Cardenolides; D012503:Saponins; C034504:digoxin-like factors; D004077:Digoxin; D004074:Digitoxin; D000254:Sodium-Potassium-Exchanging ATPase