Does Amiodarone (antiarrhythmic medication) cause Impaired Renal Function (renal damage)?

From the Guidelines

Amiodarone does not require dose adjustment in patients with chronic kidney disease (CKD) or those receiving dialysis, according to the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation 1. This suggests that amiodarone is not significantly nephrotoxic and can be used in patients with renal impairment without the need for dose adjustment. However, it is essential to note that the risk of renal damage with amiodarone is generally low but may increase with long-term use and higher doses. Some key points to consider when prescribing amiodarone to patients with renal impairment include:

• Monitoring kidney function regularly through blood tests measuring creatinine and estimated glomerular filtration rate (eGFR)
• Being aware of potential interactions with other medications that affect kidney function
• Recognizing signs of kidney dysfunction, such as decreased urine output, swelling in the legs or feet, or unexplained fatigue, and taking prompt action if they occur. It's also important to consider the benefits of amiodarone in treating life-threatening arrhythmias, which often outweigh the potential risks to kidney function for many patients 1. Overall, while amiodarone can be used in patients with renal impairment, careful monitoring and individualized treatment decisions are crucial to minimize the risk of renal damage.

From the FDA Drug Label

The following table lists the most common (incidence ≥ 2%) treatment-emergent adverse events during amiodarone HCl injection therapy considered at least possibly drug-related. Other treatment-emergent possibly drug-related adverse events reported in less than 2% of patients receiving amiodarone HCl injection in controlled and uncontrolled studies included the following: abnormal kidney function

Amiodarone may cause impaired renal function, as evidenced by reports of abnormal kidney function in patients receiving the medication. However, this occurs in less than 2% of patients.

• Key points:
  • Amiodarone has been associated with abnormal kidney function.
  • The incidence of this adverse event is less than 2%.
  • Close monitoring of patients is recommended, especially those with pre-existing renal disease 2, 2, 2.

From the Research

Amiodarone and Renal Function

• Amiodarone, an antiarrhythmic medication, has been studied for its potential effects on renal function in various research papers 3, 4, 5, 6, 7.

Evidence of Renal Damage

• A study published in 2003 found that amiodarone induces acute renal damage in rats, characterized by increased serum creatinine, decreased glomerular filtration rate, and tubular alterations 3.
• A case report from 2009 described a patient who developed acute renal failure due to amiodarone-induced hypothyroidism, which was reversible upon amiodarone withdrawal 5.
• Another study from 1993 found that creatinine elevation in patients receiving amiodarone correlates with serum amiodarone concentration, suggesting a potential link between amiodarone and renal function 7.

Pharmacokinetics and Renal Function

• A study from 1996 found that the disposition of amiodarone and its metabolite is similar in patients with normal renal function, moderate renal dysfunction, and end-stage renal disease, suggesting that dosage adjustment may not be necessary in patients with renal impairment 4.
• However, a more recent ex vivo study from 2024 found that amiodarone is heavily extracted by continuous renal replacement therapy (CRRT) circuits, which may alter its pharmacokinetics in patients with acute renal failure 6.

Key Findings

• Amiodarone may cause impaired renal function, as evidenced by increased serum creatinine and decreased glomerular filtration rate in some studies 3, 5, 7.
• The relationship between amiodarone and renal function is complex and may depend on various factors, including serum amiodarone concentration and the presence of underlying renal disease 4, 6, 7.