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Galit Kleiner-Fisman, MD; David N. Fisman, MD, FRCPC, MPH

Arch Neurol. 2007;64(6):820-824. Published online April 9, 2007 (doi:10.1001/archneur.64.6.noc60158).

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.

Author Affiliations: Parkinson's Disease Research, Education and Clinical Center, Philadelphia VA Hospital, University of Pennsylvania, Philadelphia (Dr Kleiner-Fisman); and Woodrow Wilson School of Health and Well-Being, Princeton University, Princeton, NJ (Dr Fisman). Dr Kleiner-Fisman is now with the Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario.

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RELATED LETTERS

Peripheral Edema and Dopamine Agonists in Parkinson Disease
Eng-King Tan
Arch Neurol. 2007;64(10):1546-1547.
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Peripheral Edema and Dopamine Agonists in Parkinson Disease—Reply
Galit Kleiner-Fisman and David N. Fisman
Arch Neurol. 2007;64(10):1547.
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