Evidence map›Paper›PMID 26162653›Full record

Observational studyAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2015

Outcomes After Warfarin Initiation in a Cohort of Hemodialysis Patients With Newly Diagnosed Atrial Fibrillation.

Jenny I Shen, Maria E Montez-Rath, Colin R Lenihan, Mintu P Turakhia, Tara I Chang, Wolfgang C Winkelmayer

Abstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
58citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

58 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Jenny I ShenDivision of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA.
Maria E Montez-RathDivision of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
Colin R LenihanDivision of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
Mintu P TurakhiaDivision of Cardiovascular Medicine, Department of Medicine, Palo Alto, CA; Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, CA.
Tara I ChangSection of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
Wolfgang C WinkelmayerDivision of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Division of Cardiovascular Medicine, Department of Medicine, Palo Alto, CA. Electronic address: wolfgang.winkelmayer@bcm.edu.

Funding

TRAINING PROGRAM IN ACADEMIC NEPHROLOGYT32DK007357 · NIDDK · STANFORD UNIVERSITY · PI CHERTOW, GLENN MATTHEW · 1986 to 2022
$4.8M
UCLA Clinical and Translational Science InstituteKL2TR000122 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2012 to 2015
$4.5M
The Atrial Fibrillation - Factor Identification to Risk Modification Study in HDR01DK095024 · NIDDK · STANFORD UNIVERSITY · PI WINKELMAYER, WOLFGANG CHRISTOPH · 2012 to 2023
$4.3M
Trajectories of Adherence to Cardiovascular Medications in Patients on DialysisK23DK103972 · NIDDK · LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER · PI SHEN, JENNY I · 2015 to 2019
$934k
Towards optimizing care for cardiovascular disease in chronic kidney diseaseK23DK095914 · NIDDK · STANFORD UNIVERSITY · PI CHANG, TARA I-HSIN · 2013 to 2017
$908k
Warfarin Use in ESRD Patients with Atrial Fibrillation: Risks, Benefits, BehaviorR21DK077336 · NIDDK · STANFORD UNIVERSITY · PI WINKELMAYER, WOLFGANG CHRISTOPH · 2009 to 2010
$466k
Associations among RAAS Inhibitors, Residual Kidney Function, and CV Events in PDF32DK096765 · NIDDK · STANFORD UNIVERSITY · PI SHEN, JENNY I · 2012 to 2013
$121k
NCATS NIH HHS KL2 TR000122NCATS NIH HHS KL2TR000122NIDDK NIH HHS F32 DK096765NIDDK NIH HHS F32DK096765NIDDK NIH HHS K23 DK095914NIDDK NIH HHS K23DK095914NIDDK NIH HHS K23 DK103972NIDDK NIH HHS R01 DK095024NIDDK NIH HHS R01DK095024NIDDK NIH HHS R21 DK077336NIDDK NIH HHS R21DK077336NIDDK NIH HHS T32 DK007357NIDDK NIH HHS T32DK007357
6 · The paper itself

Abstract

backgroundAlthough warfarin is indicated to prevent ischemic strokes in most patients with atrial fibrillation (AF), evidence supporting its use in hemodialysis patients is limited. Our aim was to examine outcomes after warfarin therapy initiation, relative to no warfarin use, following incident AF in a large cohort of hemodialysis patients who had comprehensive prescription drug coverage through Medicare Part D. STUDY

designRetrospective observational cohort study. SETTING &

participantsPatients in the US Renal Data System undergoing maintenance hemodialysis who had AF newly diagnosed in 2007 to 2011, with Medicare Part D coverage, who had no recorded history of warfarin use. PREDICTOR: Warfarin therapy initiation, identified by a filled prescription within 30 days of the AF event. OUTCOMES: Death, ischemic stroke, hemorrhagic stroke, severe gastrointestinal bleeding, and composite outcomes. MEASUREMENTS: HRs estimated by applying Cox regression to an inverse probability of treatment and censoring-weighted cohort.

resultsOf 12,284 patients with newly diagnosed AF, 1,838 (15%) initiated warfarin therapy within 30 days; however, ∼70% discontinued its use within 1 year. In intention-to-treat analyses, warfarin use was marginally associated with a reduced risk of ischemic stroke (HR, 0.68; 95% CI, 0.47-0.99), but not with the other outcomes. In as-treated analyses, warfarin use was associated with reduced mortality (HR, 0.84; 95% CI, 0.73-0.97). LIMITATIONS: Short observation period, limited number of nonfatal events, limited generalizability of results to more affluent patients.

conclusionsIn hemodialysis patients with incident AF, warfarin use was marginally associated with reduced risk of ischemic stroke, and there was a signal toward reduced mortality in as-treated analyses. These results support clinical equipoise regarding the use of warfarin in hemodialysis patients and underscore the need for randomized trials to fill this evidence gap.

Indexed as

Cause of DeathAdministration, OralAgedAnticoagulantsAtrial FibrillationCohort StudiesDatabases, FactualFemaleFollow-Up StudiesHumansKaplan-Meier EstimateKidney Failure, ChronicMaleMiddle AgedProportional Hazards ModelsRenal DialysisAnticoagulantsWarfarinatrial fibrillation (AF)bleedingcardiac arrhythmiaDialysisdrug safetyend-stage renal disease (ESRD)hemodialysishemorrhagic strokeischemic strokemortalityoral anticoagulationpreventionwarfarin

Identifiers

PMID26162653
PMCPMC4584203

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.