Association of atrial fibrillation and clinical outcomes in adults with chronic kidney disease: A propensity score-matched analysis

Abstract

Objective Atrial fibrillation (AF) is associated with adverse outcomes in the general population, but its impact on patients with chronic kidney disease (CKD) remains unclear. In this study, we assessed the association between AF and risks of all-cause mortality and stroke in Chinese adults with CKD. Methods We enrolled adults aged 45 years or older with CKD (defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m 2 and/or proteinuria identified using the urine dipstick method) from the Kailuan study between 2008 and 2014. AF was identified by 12-lead electrocardiography or hospital discharge diagnostic codes. Mortality data were collected from the provincial vital statistics, and physician-diagnosed ischemic or hemorrhagic stroke was confirmed in the biennial interview. Results Among the 21587 CKD adults, 216 patients were identified with AF, the median follow-up duration was 5.21 years (5.69 ± 1.96 years); During follow-up, there were 70 cases of death, and 16 cases of ischemic stroke and 6 cases of hemorrhagic stroke in the participants with AF in comparison with 2572 cases of death and 656 cases of ischemic stroke and 184 cases of hemorrhagic stroke among the participants without AF. After adjustment for potential confounders, AF was associated with an 86% increase in the rate of death (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.33-2.59, P<0.001), a 104% (HR, 2.04; 95% CI, 1.09-3.83, P = 0.026) and 325% (HR, 4.25; 95% CI, 1.74-10.36, P = 0.001) increase in the rate of ischemic stroke and hemorrhagic stroke, respectively. These associations were still consistent and strong after propensity score-matched analysis.

Chronic kidney disease and atrial fibrillation: A dangerous combination

“…Several previous studies investigated the association between stroke and atrial fibrillation in patients with chronic kidney disease [ 2 , 23 – 25 ]. In a Swedish study, it was shown that patients with atrial fibrillation had a two-fold increased risk of ischemic stroke in patient with an eGFR below the 60 ml/min /1.73 m 2 [ 2 ].…”

“…In a Swedish study, it was shown that patients with atrial fibrillation had a two-fold increased risk of ischemic stroke in patient with an eGFR below the 60 ml/min /1.73 m 2 [ 2 ]. In a study from China, atrial fibrillation was associated with a two-fold increased risk of ischemic stroke in patients with chronic kidney disease [ 23 ]. Another study, that used diagnostic codes for atrial fibrillation and stroke event and did not take albuminuria into account, showed increased ischemic stroke rates with decreasing eGFR [ 25 ].…”

“…These studies were all in line with our finding of an increased ischemic stroke risk of patients with atrial fibrillation or chronic kidney disease. However, these studies did not investigate interaction between atrial fibrillation and chronic kidney disease [ 2 , 23 , 24 ], since there was no control group with patients without chronic kidney disease and without atrial fibrillation. In addition, our study included information about albuminuria, which was lacking in previous reports [ 2 , 23 – 25 ], and outcome events were all confirmed and validated.…”

Impact of renal impairment on atrial fibrillation: ESC‐EHRA EORP‐AF Long‐Term General Registry

“…From a clinical perspective, there are many crucial aspects to consider when treating patients with AF and renal impairment. Most importantly, patients with AF suffer from an increased risk of all‐cause death and stroke, and these risks are amplified in those with co‐existing renal impairment 5 . Preventive strategies include the use of anticoagulation therapy such as warfarin, which has been shown to be influenced by renal impairment and consequently linked to poor outcomes 6 .…”

“…Most importantly, patients with AF suffer from an increased risk of all‐cause death and stroke, and these risks are amplified in those with co‐existing renal impairment. 5 Preventive strategies include the use of anticoagulation therapy such as warfarin, which has been shown to be influenced by renal impairment and consequently linked to poor outcomes. 6 Alternatively, non‐vitamin K antagonist oral anticoagulants (NOACs) may be used but these agents have varying degrees of renal excretion.…”