Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF
Year: 2018
Type: article
Abstract: Background Chronic kidney disease ( CKD ) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow‐up data were included (N=9019). CKD was defined as an estimated creatinine clearance <60 mL /min. Patient characteristics were compared by CKD status, and Cox proportional hazards modeling was used to examine the association between oral anticoagulant ( OAC ) use and outcomes and antiarrhythmic drug use and outcomes stratified by CKD stages. At enrollment, 3490 (39%) patients had an estimated creatinine clearance <60 mL /min. Patients with CKD were older and had higher CHA 2 DS 2 VAS c and Anticoagulant and Risk Factors in Atrial Fibrillation (ATRIA) scores. A rhythm control strategy was selected less frequently in patients with CKD , while OAC use was lower among Stage IV and V CKD patients. After adjustment, no significant interaction was noted for OAC and CKD on all‐cause mortality ( P =0.5442) or cardiovascular death ( P =0.1233), although a trend for increased major bleeding ( P =0.0608) and stroke, systemic embolism or transient ischemic attack ( P =0.0671) was observed. No interaction was noted for antiarrhythmic drug use and CKD status on all‐cause mortality ( P =0.9706), or stroke, systemic embolism or transient ischemic attack ( P =0.4218). Conclusions Patients with atrial fibrillation and CKD are less likely to be treated with rhythm control. Patients with advanced CKD are less likely to receive OAC . Finally, outcomes with OAC in patients with advanced CKD may be materially different with higher rates of both bleeding and stroke.
Authors: Jeffrey B. Washam, DaJuanicia N. Holmes, Laine E. Thomas, Sean D. Pokorney, Elaine M. Hylek, Gregg C. Fonarow, Kenneth W. Mahaffey, Bernard J. Gersh, Peter R. Kowey, Jack E. Ansell, Alan S. Go, James A. Reiffel, James V. Freeman, Daniel E. Singer, Gerald Naccarelli, Rosalia Blanco, Eric D. Peterson, Jonathan P. Piccini
Institutions: Duke University, Duke Medical Center, Duke Clinical Research Institute, Boston University, Ronald Reagan UCLA Medical Center, Stanford Medicine, Stanford University, Mayo Clinic, Lankenau Institute for Medical Research, Hofstra University, Kaiser Permanente, Kaiser Permanente Oakland Medical Center, Columbia University Irving Medical Center, Columbia University, Yale University, Harvard University, Massachusetts General Hospital, Pennsylvania State University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
Funders: Amgen, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, Gilead Sciences, Teva Pharmaceutical Industries, Boston Scientific Corporation, ResMed, Cipla, ARCA Biopharma, Agency for Healthcare Research and Quality, St. Jude Medical, Baxter Healthcare Corporation, Allergan, Stanford Bio-X, Janssen Pharmaceuticals, Daiichi Sankyo Europe
OpenAlex ID: W2891397155