Antidepressants and the QT interval: escitalopram and amitriptyline lengthened it most in an analysis that accounted for potassium and eGFR

The edition in brief

An individual-participant network meta-regression of 35 double-blind trials (8,679 adults with depression) found escitalopram lengthened QTc by 8.7 ms and amitriptyline by 5.3 ms versus placebo over eight weeks, after modelling baseline QTc, age, sex, BMI, serum potassium and eGFR; venlafaxine and vortioxetine were most often associated with the smallest changes. Across 139 trials, antidepressants were not associated with more early major cardiac events or non-suicidal deaths. A meta-analysis of nine cohort studies (134,598 adults) linked chronic hypoparathyroidism to a higher risk of myocardial infarction (HR 1.19), while associations with heart failure, arrhythmia, stroke, CKD and death were heterogeneous and their prediction intervals crossed no effect. A Kidney International commentary argues that frailty in children with CKD shows as lost developmental potential, should be screened for with age-appropriate tools, and may be reversible. The pearl covers sick-day guidance for kidney patients on ACE inhibitors, ARBs, SGLT2 inhibitors, diuretics and metformin.