Impact of moderate to severe renal impairment on long-term clinical outcomes in patients with atrial fibrillation

Cho, Sung Woo; Hwang, Jin Kyung; Chun, Kun–Woo; Park, Seung‐Jung; Park, Kyoung-Min; Kim, June Soo; On, Young Keun

doi:10.1016/j.jjcc.2016.04.006

Cited by 9 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…OAC could reduce 30-day mortality in AKI patients with AF in our study. Similarly, a retrospective observational study reported that moderate to severe renal impairment increased ischaemic stroke risk in AF patients not receiving antithrombotic treatments 17. Since the benefit of OAC is strongly related to the CHA2DS2-VASc score, subjects with lower CHA2DS2-VASc scores also had a decreased risk of mortality by using OAC in our study.…”

Section: Discussionsupporting

confidence: 70%

“…Similarly, a retrospective observational study reported that moderate to severe renal impairment increased ischaemic stroke risk in AF patients not receiving antithrombotic treatments. 17 Since the benefit of OAC is strongly related to the CHA2DS2-VASc score, Open access subjects with lower CHA2DS2-VASc scores also had a decreased risk of mortality by using OAC in our study. This may be due to the higher rates of thromboembolism and bleeding in patients with the deterioration of renal function, 5 18 but the absolute benefits of OAC in this population outweigh the risks, and OAC should be considered for AKI patients with AF.…”

Section: Discussionmentioning

confidence: 56%

See 1 more Smart Citation

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

Wang

2023

BMJ Open

View full text Add to dashboard Cite

ObjectiveTo find out the effect of different oral anticoagulation therapies (OAC) on mortality rate in patients with acute kidney injury (AKI) and atrial fibrillation (AF).DesignA retrospective study.SettingThis study was conducted in the Medical Information Mart for Intensive Care IV database.ParticipantsA total of 19 672 patients diagnosed with AKI.Main outcome measuresPatients were categorised into three groups: (1) AF; (2) AKI and AF, OAC−; (3) AKI and AF, OAC+. The primary endpoint was 30-day mortality. Secondary endpoints were the length of stay (LOS) in the intensive care unit (ICU) and hospital. Propensity score matching (PSM) and Cox proportional hazards model adjusted confounding factors. Linear regression was applied to assess the associations between OAC treatment and LOS.ResultsAfter PSM, 2042 pairs of AKI and AF patients were matched between the patients who received OAC and those without anticoagulant treatment. Cox regression analysis showed that, OAC significantly reduce 30-day mortality compared with non-OAC (HR 0.30; 95% CI 0.25 to 0.35; p<0.001). Linear regression analysis revealed that OAC prolong LOS in hospital (11.3 days vs 10.0 days; p=0.013) and ICU (4.9 days vs 4.4 days; p<0.001). OAC did not improve survival in patients with haemorrhage (HR 0.67; 95% CI 0.34 to 1.29; p=0.23). Novel OAC did not reduce mortality in acute-on-chronic renal injury (HR 2.03; 95% CI 1.09 to 3.78; p=0.025) patients compared with warfarin.ConclusionOAC administration was associated with improved short-term survival in AKI patients concomitant with AF.

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 56%

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

Wang

2023

BMJ Open

View full text Add to dashboard Cite

show abstract

“…In our cohort, the proportional of hypertension increased along with decreasing CrCl, up to 70.5% in the CrCl < 30 ml/ml group. Previous study showed that left ventricular EF decreased and left atrial size increased in the eGFR < 60 ml/min group (Cho et al, 2017 ). And our study showed higher proportion of DM, CAD, and previous stroke, which may affect the outcome.…”

Section: Discussionmentioning

confidence: 82%

“…The presence of renal dysfunction in AF patients was associated with a substantial increase in TE incidence and an increased risk of bleeding events (Potpara et al, 2018 ). Previous studies already demonstrated that moderate to severe renal impairment increased the risk of bleeding in AF patients (Abe et al, 2017 ; Banerjee et al, 2014 ; Cho et al, 2017 ; Yuzawa et al, 2020 ), but some other studies showed diffident results, renal impairment was not a risk factor for bleeding (Boriani et al, 2016; Kodani et al, 2018 ). This study showed renal dysfunction was not an independent predictor for major bleeding.…”

Section: Discussionmentioning

confidence: 95%

“…Recent studies have reported that moderate to severe renal impairment was a better independent predictor of all‐cause death and bleeding but not an independent predictor of TE in AF patients (Cho et al, 2017 ). Both creatinine clearance (CrCl) and estimated glomerular filtration rate (eGFR) were common tools for evaluating renal function.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Wang

Zhang

Yang

et al. 2022

Noninvasive Electrocardiol

View full text Add to dashboard Cite

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.

show abstract

The Impairment in Kidney Function in the Oral Anticoagulation Era. A Pathophysiological Insight

Scicchitano

Tucci

Bellino

et al. 2020

Cardiovasc Drugs Ther

View full text Add to dashboard Cite

Impact of moderate to severe renal impairment on long-term clinical outcomes in patients with atrial fibrillation

Abstract: Moderate to severe renal impairment is a poor prognostic factor of long-term clinical outcomes in AF patients.

Cited by 9 publications

References 39 publications

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

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

The Impairment in Kidney Function in the Oral Anticoagulation Era. A Pathophysiological Insight

Contact Info

Product

Resources

About