Spironolactone is associated with reduced risk of new-onset atrial fibrillation in patients receiving renal replacement therapy.
OBJECTIVE
Whether the spironolactone treatment remains effective for the prevention of atrial fibrillation (AF) in dialysis patients is unclear.


METHODS
We used a database from the Registry for Catastrophic Illness from the National Health Research Institute. All dialysis patients aged 18 or older without history of AF before ESRD were incorporated. A total of 113,191 dialysis patients were enrolled in the study. The median follow-up time was 4.17 years. We collected information on prescribed drug dosage, number of days of treatment and the total number of pills dispensed from the outpatient pharmacy prescription database. All individuals in the study cohort with the first occurrence of AF were included as cases.


RESULTS
In spironolactone group, the incidence of developing new AF was significantly lower than that in the control group both before (0.8% vs. 3.3%, P=0.019) and after PS matching (1.2% vs. 3.0%, P=0.019). Before PS matching, Cox's proportional hazard regression analyses showed that spironolactone was associated with 60% reduction of new AF (HR=0.372 [0.200-0.692], P=0.002) and the protective effect is dose-responsive in accumulated dose, treatment duration and mean daily dose. After PS matching, the overall AF prevention effect remained significant (HR=0.400 [0.179-0.895], P=0.026) while the dose-response relationship became borderline significant. Subgroup analyses showed that the protective effect was more evident in some specific subgroup patients.


CONCLUSIONS
Our study showed that spironolactone therapy was associated with lower risk of developing AF in a dose-responsive manner in patients with dialysis. Further randomized study is needed to confirm this observation.
Division of Cardiology, Department of Internal Medicine, Chi Mei hospital, Taiwan.
Yi-Wei
YW
Chung
Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan, University College of Public Health, Taipei, Taiwan.
Yao-Hsu
YH
Yang
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Cho-Kai
CK
Wu
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Chih-Chieh
CC
Yu
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Jyh-Ming Jimmy
JM
Juang
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Yi-Chih
YC
Wang
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Chia-Ti
CT
Tsai
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Lian-Yu
LY
Lin
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Ling-Ping
LP
Lai
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Juey-Jen
JJ
Hwang
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Fu-Tien
FT
Chiang
Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Pau-Chung
PC
Chen
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan. Electronic address: hspenos@gmail.com.
Jiunn-Lee
JL
Lin
D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000175:diagnosis*; D016208:Databases, Factual; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D017582:Renal Replacement Therapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
D004232:Diuretics; D013148:Spironolactone
Atrial fibrillation; ESRD; Hemodialysis; Spironolactone