Abstract: TH-PO118
Comparative Sudden Cardiac Death Risk of Haloperidol vs. Chlorpromazine among People Receiving Hemodialysis
Session Information
- Pharmacology
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Ismail Atta, Sherin, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
- Nash, Rebekah P., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Gaynes, Bradley N., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Flythe, Jennifer E., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
Background
Sudden cardiac death (SCD) is the leading cause of death in the hemodialysis population. Haloperidol and chlorpromazine are the most prescribed typical antipsychotic agents in this population, and both agents have known QT-interval prolonging potential. Data from the non-dialysis population suggest that chlorpromazine may confer higher SCD risk than haloperidol. However, the comparative cardiac safety of these agents in the hemodialysis population is unknown.
Methods
We conducted a new-user, active-comparator, cohort study using US Renal Data System data (2007-2019) to assess the comparative 1-year risk of SCD between initiators of haloperidol vs. chlorpromazine. We used inverse probability of treatment weighting and Fine and Gray proportional subdistribution hazard models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). We used an intention-to-treat approach and treated non-SCD as a competing event. In secondary analyses, we considered broader cardiac outcomes.
Results
Among 10,225 individuals receiving maintenance hemodialysis, 6,266 (61%) initiated haloperidol and 3,959 (39%) initiated chlorpromazine. The median (interquartile range, IQR) age was 65 (55, 74) years, median (IQR) dialysis vintage was 3.1 (1.4, 5.6) years, and 34.9% were female. Haloperidol vs. chlorpromazine initiation was associated with higher relative and absolute 1-year risks of SCD, aHR (95% CI) = 1.39 (1.21, 1.59); weighted risk difference (95% CI) = 2.62% (-0.27, 5.51). The number needed to harm was 38 for haloperidol initiations. Analyses of other cardiac outcomes yielded similar findings.
Conclusion
Initiation of haloperidol vs. chlorpromazine associates with higher absolute and relative 1-year risks of SCD among hemodialysis patients. Our findings may inform prescribing decisions.
Figure 1. The 1-year risk of sudden cardiac death (%) among hemodialysis patients initiating haloperidol vs. chlorpromazine.
Funding
- Other NIH Support