Is There Association Between Changes in eGFR Value and the Risk of Permanent Type of Atrial Fibrillation? - Analysis of Valvular and Non-Valvular Atrial Fibrillation Population

Background/Aims: There are no data concerning renal function in population with valvular and non-valvular atrial fibrillation (AF). To assess renal function in patients with AF, the association between eGFR and AF perpetuation, in-hospital mortality. Methods: We studied 1523 patients with AF. Patients with chronic kidney disease (CKD) were compared to population with preserved renal function. Results: CKD was more frequently observed in patients with valvular AF(p=0.009). In non-valvular AF patients eGFR <60ml/min./1,73m2 had more often permanent AF(p<0.0001). In patients with CKD CHA2DS2VASc score was 4.1±1.5 and HAS-BLED score was 2.1±1.2 and it was higher as compared to population with preserved renal function (p<0.0001 vs p<0.0001). The odds of permanent AF in patients with non-valvular AF and CKD were increased 1.82 times(OR=1.82,p<0.0001,95%CI:1.46-2.27). The odds of permanent AF in patients with valvular AF and CKD were not significantly increased(OR=1.46,p=0.2,95%CI:0.86-2.5). In non-valvular AF, if eGFR decrease by 10ml/min, odds of permanent AF are increased by 10%(OR=1.1p<0.0001,95%CI1.05- 1.15). In multivariate logistic regression, in non-valvular AF, odds of in-hospital death were higher for patients >75 years old(OR=3.70,p=0.01,95%CI1.33-10.28), with CKD (OR=2.61,p=0.03,95%CI1.09-6.23). The type of AF had no significant influence on in-hospital mortality(OR=0.71,p=0.45,95%CI0.30-1.70). Conclusions: CKD is more often observed in patients with valvular AF. In population with non-valvular AF decreased eGFR is associated with permanent type of AF and with higher CHA2DS2VASc and HAS-BLED score. Among valvular AF patients there are no differences in type of AF between patients with and without CKD. There is the correlation between CKD and AF perpetuation but only in non-valvular population.

[1]  M. Ezekowitz,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. , 2014, Circulation.

[2]  S. Fu,et al.  Different types of atrial fibrillation, renal function, and mortality in elderly Chinese patients with coronary artery disease , 2014, Clinical interventions in aging.

[3]  G. Lip,et al.  Renal function and outcomes in anticoagulated patients with non-valvular atrial fibrillation: the AMADEUS trial. , 2013, European heart journal.

[4]  M. Wright,et al.  Management of atrial fibrillation in chronic kidney disease: double trouble. , 2013, American heart journal.

[5]  D. Atar,et al.  Mass screening for silent atrial fibrillation in high risk patients - preliminary results from the STROKESTOP trial , 2013 .

[6]  Jeroen J. Bax,et al.  2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. , 2012, European heart journal.

[7]  Gerhard Hindricks,et al.  2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[8]  O. Alfieri,et al.  Guidelines on the management of valvular heart disease (version 2012). , 2012, European heart journal.

[9]  J. Spertus,et al.  The prevalence of and factors associated with chronic atrial fibrillation in Medicare/Medicaid-eligible dialysis patients. , 2012, Kidney international.

[10]  Bertram L Kasiske,et al.  Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). , 2011, Kidney international.

[11]  Josef Coresh,et al.  Chronic Kidney Disease Is Associated With the Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study , 2011, Circulation.

[12]  Kortaro Tanaka,et al.  Chronic kidney disease and CHADS(2) score independently predict cardiovascular events and mortality in patients with nonvalvular atrial fibrillation. , 2011, The American journal of cardiology.

[13]  Elsayed Z Soliman,et al.  Association of Chronic Kidney Disease With Atrial Fibrillation Among Adults in the United States: REasons for Geographic and Racial Differences in Stroke (REGARDS) Study , 2011, Circulation. Arrhythmia and electrophysiology.

[14]  Jeroen J. Bax,et al.  Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). , 2010, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[15]  A. Go,et al.  Chronic kidney disease and prevalent atrial fibrillation: the Chronic Renal Insufficiency Cohort (CRIC). , 2010, American heart journal.

[16]  E. Lerma,et al.  Prevalence of atrial fibrillation and its predictors in nondialysis patients with chronic kidney disease. , 2010, Clinical journal of the American Society of Nephrology : CJASN.

[17]  S. Yusuf,et al.  Dabigatran versus warfarin in patients with atrial fibrillation. , 2009, The New England journal of medicine.

[18]  Tom Greene,et al.  Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate (Annals of Internal Medicine (2006) 145, (247-254)) , 2008 .

[19]  Maria Grazia Valsecchi,et al.  Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. , 2008, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[20]  J. Gardin,et al.  Burden of valvular heart diseases: a population-based study , 2006, The Lancet.

[21]  Essam Elsayed,et al.  Cardiovascular outcomes and all-cause mortality: exploring the interaction between CKD and cardiovascular disease. , 2006, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[22]  Tom Greene,et al.  Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate , 2006, Annals of Internal Medicine.

[23]  M. Valsecchi,et al.  Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[24]  Robert M Califf,et al.  Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. , 2004, The New England journal of medicine.

[25]  Philippe Ravaud,et al.  A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. , 2003, European heart journal.

[26]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[27]  R. Troughton,et al.  Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. , 2011, The New England journal of medicine.

[28]  Helmut Baumgartner,et al.  Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology , 2007 .