Key result
Chronic kidney disease shows no association with 180-day mortality after initiating digoxin for NVAF.
Why the study?
Does the presence of chronic kidney disease increase all-cause or cardiovascular mortality in patients with non-valvular atrial fibrillation treated with digoxin?
Cohort (n=37,981)
Does the presence of chronic kidney disease increase all-cause or cardiovascular mortality in patients with non-valvular atrial fibrillation treated with digoxin?
Hazard Ratio: 0.89 (95% CI 0.78–1.03)
In patients with non-valvular atrial fibrillation initiating digoxin, the presence of chronic kidney disease was not independently associated with increased all-cause or cardiovascular mortality at 180 days or 2 years.
CKD was not associated with higher mortality on digoxin in NVAF; leaves open need for randomized confirmation before changing practice.
PURPOSE: This study investigated the impact of chronic kidney disease on all-causes and cardiovascular mortality in patients with atrial fibrillation treated with digoxin. METHODS: All 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. RESULTS: We 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. CONCLUSIONS: 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.
No takes yet. Share an insight, caveat, or question.
Sessa et al. (2016) conducted a cohort in Non-valvular atrial fibrillation (n=37,981). Chronic kidney disease vs. No chronic kidney disease was evaluated on All-cause mortality within 180 days (HR 0.89, 95% CI 0.78-1.03). Chronic kidney disease had no statistically significant effect on all-cause mortality (HR 0.89) or cardiovascular mortality within 180 days of initiating digoxin for non-valvular atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: