{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:15:39Z","timestamp":1793398539446,"version":"4.5.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,9,18]]},"abstract":"\n Background<\/jats:title>\n \n Chronic kidney disease (\n CKD<\/jats:styled-content>\n ) is a common comorbidity in patients with atrial fibrillation. The presence of\n CKD<\/jats:styled-content>\n complicates drug selection for stroke prevention and rhythm control.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Patients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow\u2010up data were included (N=9019).\n CKD<\/jats:styled-content>\n was defined as an estimated creatinine clearance <60\n mL<\/jats:styled-content>\n \/min. Patient characteristics were compared by\n CKD<\/jats:styled-content>\n status, and Cox proportional hazards modeling was used to examine the association between oral anticoagulant (\n OAC<\/jats:styled-content>\n ) use and outcomes and antiarrhythmic drug use and outcomes stratified by\n CKD<\/jats:styled-content>\n stages. At enrollment, 3490 (39%) patients had an estimated creatinine clearance <60\n mL<\/jats:styled-content>\n \/min. Patients with\n CKD<\/jats:styled-content>\n were older and had higher\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n VAS<\/jats:styled-content>\n c and Anticoagulant and Risk Factors in Atrial Fibrillation (ATRIA) scores. A rhythm control strategy was selected less frequently in patients with\n CKD<\/jats:styled-content>\n , while\n OAC<\/jats:styled-content>\n use was lower among Stage\n IV<\/jats:styled-content>\n and V\n CKD<\/jats:styled-content>\n patients. After adjustment, no significant interaction was noted for\n OAC<\/jats:styled-content>\n and\n CKD<\/jats:styled-content>\n on all\u2010cause mortality (\n P<\/jats:italic>\n =0.5442) or cardiovascular death (\n P<\/jats:italic>\n =0.1233), although a trend for increased major bleeding (\n P<\/jats:italic>\n =0.0608) and stroke, systemic embolism or transient ischemic attack (\n P<\/jats:italic>\n =0.0671) was observed. No interaction was noted for antiarrhythmic drug use and\n CKD<\/jats:styled-content>\n status on all\u2010cause mortality (\n P<\/jats:italic>\n =0.9706), or stroke, systemic embolism or transient ischemic attack (\n P<\/jats:italic>\n =0.4218).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Patients with atrial fibrillation and\n CKD<\/jats:styled-content>\n are less likely to be treated with rhythm control. Patients with advanced\n CKD<\/jats:styled-content>\n are less likely to receive\n OAC<\/jats:styled-content>\n . Finally, outcomes with\n OAC<\/jats:styled-content>\n in patients with advanced\n CKD<\/jats:styled-content>\n may be materially different with higher rates of both bleeding and stroke.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008928","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T21:08:33Z","timestamp":1537218513000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT\u2010AF"],"prefix":"10.1161","volume":"7","author":[{"given":"Jeffrey B.","family":"Washam","sequence":"first","affiliation":[{"name":"Duke Heart Center Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DaJuanicia N.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laine E.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean D.","family":"Pokorney","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"},{"name":"Department of Medicine Duke University School of MedicineDurham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine M.","family":"Hylek","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ronald Reagan\u2010UCLA Medical Center Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth W.","family":"Mahaffey","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard J.","family":"Gersh","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R.","family":"Kowey","sequence":"additional","affiliation":[{"name":"Lankenau Institute for Medical Research Wynnewood PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack E.","family":"Ansell","sequence":"additional","affiliation":[{"name":"Hofstra North Shore\/LIJ School of Medicine Hempstead NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S.","family":"Go","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Oakland CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Reiffel","sequence":"additional","affiliation":[{"name":"Department of Medicine Columbia University College of Physicians and Surgeons New 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Institute Durham NC"},{"name":"Department of Medicine Duke University School of MedicineDurham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P.","family":"Piccini","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"},{"name":"Department of Medicine Duke University School of MedicineDurham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.195"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021328"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021375"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.07.001"},{"key":"e_1_3_1_10_2","volume-title":"Applied Missing Data Analysis","author":"Enders CK","year":"2010","unstructured":"Enders CK. 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New York, NY: Guilfod Press; 2010."},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.12.019"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.004777"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2009030319"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04550511"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105594"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.008928","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:21:35Z","timestamp":1715599295000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.008928"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,18]]},"references-count":14,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2018,9,18]]}},"alternative-id":["10.1161\/JAHA.118.008928"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.008928","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,18]]},"assertion":[{"value":"2018-04-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e008928"}}