Renal function and mortality in patients with atrial fibrillation

Abstract

AimThe aim of this study is to examine the association of the presence of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) values with mortality in patients with atrial fibrillation.MethodsThis posthoc analysis of a randomized controlled trial consisted of hospitalized patients with atrial fibrillation who were followed up for a median of 2.7 years after discharge. Kaplan–Meier curves, multivariate Cox-regression and spline curves were utilized to assess the association of CKD, CKD stages 2–5 according to the KDOQI guidelines, and the continuum of eGFR values with the primary outcome of all-cause death, and the secondary outcome of cardiovascular mortality.ResultsOut of 1064 hospitalized patients with atrial fibrillation, 465 (43.7%) had comorbid CKD. The presence of CKD was associated with an increased risk for both all-cause and cardiovascular mortality following hospitalization [adjusted hazard ratio (aHR): 1.60; 95% confidence intervals (95% CIs): 1.25–2.05 and aHR: 1.74; 95% CI: 1.30–2.33, respectively]. The aHRs for all-cause mortality in CKD stages 2–5, as compared with CKD stage 1 were 2.18, 2.62, 4.20 and 3.38, respectively (all P < 0.05). In spline curve analyses, eGFR values lower than 50 ml/min/1.73 m2 were independent predictors of higher all-cause and cardiovascular mortality.ConclusionIn recently hospitalized patients with atrial fibrillation, the presence of CKD was independently associated with decreased survival, which was significant across CKD stages 2–5, as compared with CKD stage 1. Values of eGFR lower than 50 ml/min/1.73 m2 were incrementally associated with worse prognosis.

CHA2DS2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease

“…In a recent study in hospitalized patients with atrial fibrillation with 2.7 years of follow-up, the presence of CKD was independently associated with reduced survival, and an estimated Glomerular Filtration Rate (eGFR) < 50 ml/min/1.73 m 2 was associated with worse prognosis [ 5 ].…”

The epidemiology and mortality of patients with atrial fibrillation: a complex landscape

“…The primary cause of death is usually not related to the arrhythmia itself nor to stroke, but instead to comorbidities and complications. [23][24][25][26][27] Indeed, approximately only 1 out of 10 AF-related deaths can be attributed to stroke, while !7 out of 10 are due to cardiovascular causes. 28 Furthermore, oral anticoagulants have been proven to prevent stroke and impact on patient prognosis.…”

“…AF is a multifaceted and multisystem disease, with complex multidirectional interactions with its risk factors, associated comorbidities, lifestyle and the environment. The primary cause of death is usually not related to the arrhythmia itself nor to stroke, but instead to comorbidities and complications 23–27 . Indeed, approximately only 1 out of 10 AF-related deaths can be attributed to stroke, while ≥7 out of 10 are due to cardiovascular causes 28 .…”

Treatment of aortic stenosis in dialysis: a necessary update in a challenging population

“…In general, patients with CKD and cardiovascular diseases require special consideration. [11][12][13] Specifically, patients with aortic stenosis and ESRD requiring dialysis represent a challenging population from diagnosis to treatment. Dyspnoea and chest pain can be attributable to aortic stenosis but also to conditions related to CKD, such as anaemia, protein-wasting energy syndrome and fluid overload.…”

“…In general, patients with CKD and cardiovascular diseases require special consideration 11–13 . Specifically, patients with aortic stenosis and ESRD requiring dialysis represent a challenging population from diagnosis to treatment.…”