Risk factors for the development of pedal edema in patients using pramipexole.

OBJECTIVE To determine risk factors for pedal edema among patients with Parkinson disease (PD) using pramipexole hydrochloride therapy. DESIGN A retrospective medical record review. SETTING Philadelphia Veterans Administration Parkinson's Disease Research, Education and Clinical Center (PADRECC). PATIENTS All consecutive patients at the PADRECC receiving pramipexole from December 2002 to December 2004. MAIN OUTCOME MEASURES Bivariable and multivariable logistic regression models were used to identify comorbid illnesses, demographic characteristics, other medications, and PD features associated with increased risk of pedal edema among individuals taking pramipexole. Estimation of time to development of pedal edema in individuals taking pramipexole was performed using Kaplan-Meier survival methods and multivariable Cox proportional hazards models. RESULTS Two hundred thirty-seven PADRECC patients received pramipexole and met criteria for inclusion in the analysis. Of these, 38 (16%) developed pedal edema. Multivariable regression models identified idiopathic PD (odds ratio [OR], 4.80; 95% confidence interval [CI], 1.54-14.98; P = .007), history of coronary artery disease (OR, 3.35; 95% CI, 1.51-7.46; P = .003), and history of diabetes mellitus (OR, 3.12; 95% CI, 1.01-9.60; P = .05) as strong independent risk factors for development of edema. There was no relationship between dose of pramipexole and incidence and severity of pedal edema. The risk of development of pedal edema was 7.7% (95% CI, 4.5%-12.9%) in the first year after initiation of pramipexole therapy, with more rapid development of edema among those with a history of coronary artery disease. CONCLUSIONS Pedal edema is a relatively common outcome in patients with PD receiving pramipexole. History of coronary artery disease increases the risk for developing edema.