背景:心率控制是慢性肾脏病(CKD)患者房颤(AF)最常用的一线治疗策略。用于控制心率(HR)的主要药物包括β受体阻滞剂(BB)和非二氢吡啶类钙通道阻滞剂(ND-CCB)。然而,关于这些药物在CKD患者中的差异的已发表研究很少.
目的:本研究旨在调查差异,由于人力资源控制不佳而住院,在根据肾小球滤过率(GFR)进行速率控制策略的房颤患者中。
方法:该研究队列包括2014年1月至2020年4月期间在速率控制方案(BB或ND-CCB)下的2804例房颤患者。终点,由竞争风险回归决定,是伴有快速心室反应(RVR)的房颤住院,慢心室反应(SVR),需要起搏器。
结果:关于多变量分析,对于GFR>60mL/min/1.73m2(亚分布心率[sHR]0.850,95%置信区间[CI]:0.61-1.19;p=.442)和GFR30-59mL/min/1.73m2(sHR1.242,95%CI:0.80-1.63;p=333)的受试者,ND-CCB和BB之间没有统计学差异,而在GFR<30mL/min/1.73m2的患者中,由于HR控制不佳,ND-CCB治疗与住院率增加相关(sHR4.53,95%CI:1.19~17.18;p=.026).
结论:在GFR≥30mL/min/1.73m2的患者中,由于HR控制不佳,ND-CCB或BB的选择对住院没有影响,而在GFR<30mL/min/1.73m2时,检测到可能的关联。这些药物对GFR<30mL/min/1.73m2的影响需要进一步研究。
BACKGROUND: Rate control is the most commonly employed first-line management strategy for atrial fibrillation (AF) in patients with chronic kidney disease (CKD). Principal agents used to control heart rate (HR) include beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB). However, there is a paucity of published studies of the differences between those drugs in CKD patients.
OBJECTIVE: The present study aimed to investigate the differences, in terms of hospitalizations due to a poor HR control, in patients with AF under a rate-control strategy according to glomerular filtration rate (GFR).
METHODS: The study cohort included 2804 AF patients under rate-control regime (BB or ND-CCB) between January 2014 and April 2020. The end point, determined by competing risk regression, was hospitalizations for AF with rapid ventricular response (RVR), slow ventricular response (SVR), and need for pacemaker.
RESULTS: On multivariate analysis, there were no statistical differences between ND-CCB and BB for subjects with GFR > 60 mL/min/1.73 m2 (subdistribution heart rate [sHR] 0.850, 95% confidence interval [CI]: 0.61-1.19; p = .442) and GFR 30-59 mL/min/1.73 m2 (sHR 1.242, 95% CI: 0.80-1.63; p = .333), while in patients with GFR < 30 mL/min/1.73 m2, ND-CCB therapy was associated with increased hospitalizations due to poor HR control (sHR 4.53, 95% CI: 1.19-17.18; p = .026).
CONCLUSIONS: In patients with GFR ≥ 30 mL/min/1.73 m2, the choice of ND-CCB or BB had no impact on hospitalizations due to poor HR control, while in GFR < 30 mL/min/1.73 m2, a possible association was detected. The effects of these drugs on GFR < 30 mL/min/1.73 m2 would require further investigation.