The following is a summary of “Ondansetron and the Risk of Sudden Cardiac Death among Individuals Receiving Maintenance Hemodialysis,” published in the February 2024 issue of Nephrology by Ismail et al.

Researchers conducted a retrospective study to investigate the cardiac safety of intravenously administered ondansetron in hemodialysis patients, considering its potential for QT interval prolongation and the risk of fatal arrhythmias observed in the general population.

They conducted a new-user, active-comparator cohort study utilizing US Renal Data System data (2012 to 2019). The study aimed to assess the relationship between the initiation of oral ondansetron compared to antiemetics with lesser QT-prolonging potential (promethazine, metoclopramide, or prochlorperazine) and the 10-day risk of sudden cardiac death in individuals undergoing hemodialysis. Inverse probability of treatment-weighted survival models was employed to calculate adjusted HRs (aHRs),  adjusted RDs (aRDs), and their respective 95% CIs. An intention-to-treat approach was adopted, where non-sudden cardiac death was treated as a competing event. Secondary analyses were conducted to explore additional cardiac outcomes.

The results showed that out of the 119,254 study patients, 64,978 (54.5%) began ondansetron, while 54,276 (45.5%) started comparator antiemetic. Starting ondansetron as opposed to a comparator antiemetic was linked to higher relative and absolute 10-day risks of sudden cardiac death, with an aHRs (95% CI) of 1.44 (1.08, 1.93) and an aRDs (95% CI) of 0.06% (0.01%, 0.11%). The number needed to harm stood at 1,688. Additional analyses on cardiac outcomes revealed consistent results.

Investigators concluded that starting ondansetron, compared to other anti-nausea medications with lower QT prolongation risk, increases short-term heart risk in hemodialysis patients.

Source: journals.lww.com/jasn/abstract/9900/ondansetron_and_the_risk_of_sudden_cardiac_death.264.aspx