Glomerular filtration rate: A prognostic marker in atrial fibrillation—A subanalysis of the AntiThrombotic Agents Atrial Fibrillation

Proietti, Riccardo; Gonzini, Lucio; Pizzimenti, G.; Ledda, Antonietta; Sanna, Pietro Paolo; AlTurki, Ahmed; Russo, Vincenzo; Lencioni, Mauro; Investigators, Ata-Af

doi:10.1002/clc.23065

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…While many authors detected a higher proportion of men in AF patients with CKD, Prioetti et al and Reinecke et al reported a higher proportion of women than men in AF patients with CKD. [ 26 , 33 ] We failed to find a difference in gender proportion between CKD and non-CKD patients. Reinecke et al speculated whether a higher proportion of women could be a reflection of previous higher mortality in men.…”

Section: Discussionmentioning

confidence: 85%

“…In the linear regression analysis, CV mortality was independently associated with eGFR (β= 0.169, P = .04) what is in line with the results of Parsons et al [ 31 ] who found that lower GFR significantly correlated with mortality and following data of Proietti et al where eGFR < 60 ml/min/1.73 m 2 was associated with higher CV mortality rate. [ 26 ] It was observed in J Rhythm and ATA-AF registries that even moderately impaired GFR was independently associated with CV mortality and worse prognosis among patients with AF while Guo et al reported that renal dysfunction carries a greater risk of stroke and death in women. [ 32 , 36 , 37 ]…”

Section: Discussionmentioning

confidence: 99%

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Chronic kidney disease and cardiovascular mortality in patients with atrial fibrillation

Premužić

Stevanović

Radić³

et al. 2021

Medicine

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Our aim was to analyze characteristics of atrial fibrillation (AF) patients with chronic kidney disease (CKD) from the Croatian cohort of the ESH A Fib survey and to determine the association of estimated glomerular filtration rate (eGFR) with cardiovascular (CV) mortality after 24 months of follow-up. Consecutive sample of 301 patients with AF were enrolled in the period 2014 to 2018. Hypertension was defined as BP > 140/90 mm Hg and/or antihypertensive drugs treatment, CKD was defined as eGFR (CKD Epi) < 60 ml/min/1.73 m2 which was confirmed after 3 months. CKD was diagnosed in 45.2% of patients (13.3% in CKD stage > 3b). CKD patients were older than non-CKD and had significantly more frequent coronary heart disease, heart failure and valvular disease. CKD patients had significantly higher CHA2DS2-VASc score and more CKD than non-CKD patients had CHA2DS2-VASc > 2. Crude CV mortality rate per 1000 population at the end of the first year of the follow-up was significantly higher in CKD vs non-CKD group who had shorter mean survival time. CV mortality was independently associated with eGFR, male gender, CHA2DS2VASc and R2CHA2DS2VASc scores. Prevalence of CKD, particularly more advanced stages of CKD, is very high in patients with AF. Observed higher CV mortality and shorter mean survival time in CKD patients could be explained with higher CHA2DS2VASc score which is a consequence of clustering of all score components in CKD patients. However, eGFR was independently associated with CV mortality. In our cohort, R2CHA2DS2VASc score was not associated significantly more with CV mortality than CHA2DS2VASc score.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease and cardiovascular mortality in patients with atrial fibrillation

Premužić

Stevanović

Radić³

et al. 2021

Medicine

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“…Our results were consistent with some other AF registry studies; Boriani et al ( 2016 ) assessed 1‐year outcomes in patients with AF enrolled in the EurObservational Research Programme AF General Pilot Registry, they enrolled 2398 AF patients and found that renal function was a major determinant of adverse outcomes at 1 year, and even mild or moderate renal impairments were associated with an increased risk of all‐cause death (OR 3.64 for estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m 2 , OR 3.30 for 30–49 ml/min/1.73m 2 , and OR 2.09 for 50–79 ml/min/1.73 m 2 vs. eGFR≥80 ml/min/1.73 m 2 ). Proietti et al (Proietti et al, 2018 ) performed on the data of the Antithrombotic Agents Atrial Fibrillation study and showed that impaired eGFR ( < 60 ml/min/1.73 m 2 ) heralds a higher risk for cardiovascular morbidity and all‐cause mortality among patients with AF. In the Fushimi AF Registry study (Abe et al, 2017 ), AF Patients with CrCl < 30 ml/min had the greatest risk s of all‐cause death, stroke, major bleeding, and hospitalization for myocardial infarction and HF.…”

Section: Discussionmentioning

confidence: 99%

“…eGFR≥80 ml/min/1.73 m 2 ). Proietti et al (Proietti et al, 2018) performed on the data of the Antithrombotic Agents Atrial Fibrillation study and showed that impaired eGFR ( < 60 ml/min/1.73 m 2 ) heralds a higher risk for cardiovascular morbidity and all-cause mortality among patients with AF. In the Fushimi AF Registry study (Abe et al, 2017), AF Patients with CrCl < 30 ml/min had the greatest risk s of all-cause death, stroke, major bleeding, and hospitalization for myocardial infarction and HF.…”

Section: Renal Impairment and Deathmentioning

confidence: 99%

Relationship between creatinine clearance and clinical outcomes in Chinese emergency patients with atrial fibrillation

Wang

Zhang

Yang

et al. 2022

Noninvasive Electrocardiol

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Background: Few real-world data on the relation between creatinine clearance (CrCl) and adverse clinical outcomes in Chinese emergency department (ED) patients with nonvalvular atrial fibrillation (AF). Methods:In this prospective, observational, multicenter AF study, enrolled AF patients presenting to an ED at 20 hospitals in China from November 2008 to October 2011, with a follow-up of 12 month. A total of 863 AF patients with CrCl data were analyzed, and patients were categorized as CrCl ≥ 80, 50 ≤ CrCl < 80, 30 ≤ CrCl < 50, and CrCl < 30(ml/min). Outcomes of analyses were all-cause death, cardiovascular death, thromboembolism (TE), and major bleeding.Results: Among the whole patients, 126(14.6%) patients died during 12-month follow-up, 53(40.2%) among CrCl < 30 ml/min group, and 48(16.2%), 22(6.5%), and 3(3.2%) among 30 ≤ CrCl50, 50 ≤ Crl < 80, and CrCl ≥ 80 ml/min groups, respectively (p < 0.001). Cardiovascular death and TE rates also increased with decreasing CrCl. On multivariate analysis, patients with CrCl < 30 ml/min were associated with higher risks of all-cause death (HR 5.567;; p = .007) and higher cardiovascular death (HR11.939; 95%CI1.439-99.031; p = .022) as compared with CrCl≥80 ml/min category. Nevertheless, for TE and major bleeding risk, CrCl groups showed no significant difference after adjustment for variables in CHA 2 DS 2 -VASc score and status of warfarin prescription in our cohort. Conclusions:In Chinese ED nonvalvular AF patients, incidence rates of death increased with reducing CrCl across the whole range of renal function. CrCl < 30 ml/ min was associated with all-cause death, cardiovascular death, but not for TE and major bleeding.

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“…Once appeared, AF favors CKD progression resulting in a vicious cycle [ 4 , 5 ]. Thromboembolic complications typical of AF are amplified in patients with renal dysfunction, who may have a hypercoagulable state due to increased platelet activity, activation of the renin-angiotensin-aldosterone system, altered vessel wall contractility and vascular endothelium changes, increasing the risk of stroke by 50% [ 4 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Evidence for the Choice of the Direct Oral Anticoagulant in Patients with Atrial Fibrillation According to Creatinine Clearance

et al. 2021

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Atrial fibrillation (AF) often coexists with chronic kidney disease (CKD), which confer to the patient a higher risk of both thromboembolic and hemorrhagic events. Oral anticoagulation therapy, nowadays preferably with direct oral anticoagulants (DOACs), represents the cornerstone for ischemic stroke prevention in high-risk patients. However, all four available DOACs (dabigatran, apixaban, rivaroxaban and edoxaban) are eliminated by the kidneys to some extent. Reduced kidney function facilitates DOACs accumulation and, therefore, different dose reductions are required, with slight differences between American and European recommendations especially in case of severe renal impairment (creatinine clearance < 30 mL/min). Overall, the use of DOACs in patients with non-end stage CKD and AF is effective similarly to warfarin, showing a better safety profile. The management of thromboembolic risk among patients with AF on dialysis remains challenging, as warfarin effectiveness for stroke prevention in this population is questionable and retrospective data on apixaban need to be confirmed on a larger scale. In kidney transplant recipients, DOACs may provide a potentially safer option compared to warfarin, but co-administration with immunosuppressants is a matter of concern.

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Glomerular filtration rate: A prognostic marker in atrial fibrillation—A subanalysis of the AntiThrombotic Agents Atrial Fibrillation

Abstract: The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF.

Cited by 6 publications

References 27 publications

Chronic kidney disease and cardiovascular mortality in patients with atrial fibrillation

Chronic kidney disease and cardiovascular mortality in patients with atrial fibrillation

Relationship between creatinine clearance and clinical outcomes in Chinese emergency patients with atrial fibrillation

Clinical Evidence for the Choice of the Direct Oral Anticoagulant in Patients with Atrial Fibrillation According to Creatinine Clearance

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