Abstract
PurposeThis study investigated the impact of chronic kidney disease on all-causes and cardiovascular mortality in patients with atrial fibrillation treated with digoxin.MethodsAll patients with non-valvular atrial fibrillation and/or atrial flutter as hospitalization diagnosis from January 1, 1997 to December 31, 2012 were identified in Danish nationwide administrative registries. Cox proportional hazard model was used to compare the adjusted risk of all-causes and cardiovascular mortality among patients with and without chronic kidney disease and among patients with different chronic kidney disease stages within 180 days and 2 years from the first digoxin prescription.ResultsWe identified 37,981 patients receiving digoxin; 1884 patients had the diagnosis of chronic kidney disease. Cox regression analysis showed no statistically significant differences in all-causes (Hazard Ratio, HR 0.89; 95% confident interval, CI 0.78–1.03) and cardiovascular mortality (HR 0.88; 95%CI 0.74–1.05) among patients with and without chronic kidney disease within 180 days of follow-up period. No statistically significant differences was found using a 2 years follow-up period neither for all causes mortality (HR 0.90; 95%CI 0.79–1.03), nor for cardiovascular mortality (HR 0.87; 95%CI 0.74–1.02). No statistically significant differences was found comparing patients with and without estimated Glomerular Filtration Rate <30ml/min/1.73m2 and patients with different stages of chronic kidney disease, for all-causes and cardiovascular mortality within 180 days and 2 years from the first digoxin prescription.ConclusionsThis study suggest no direct effect of chronic kidney disease and chronic kidney disease stages on all-causes and cardiovascular mortality within both 180 days and 2 years from the first digoxin prescription in patients treatment-naïve with digoxin for non-valvular atrial fibrillation.
Highlights
A main strategy to treat atrial fibrillation is heart rate control
We identified 37,981 patients receiving digoxin; 1884 patients had the diagnosis of chronic kidney disease
This study suggest no direct effect of chronic kidney disease and chronic kidney disease stages on all-causes and cardiovascular mortality within both 180 days and 2 years from the first digoxin prescription in patients treatment-naïve with digoxin for non-valvular atrial fibrillation
Summary
A main strategy to treat atrial fibrillation is heart rate control. After the postDigoxin Investigation Group trial era [5], digoxin is commonly used worldwide as heart rate control agent in the treatment of atrial fibrillation [6]. Atrial fibrillation and kidney disease are commonly found in the same patient and prior studies have shown that the presence of one condition increased the likelihood of finding the other [30,31,32,33]. Patients with chronic kidney disease have generally been excluded from clinical trials, register based studies are currently the best opportunity to gain further insight [29,33]
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