Clinical outcomes associated with kidney function changes in anticoagulated atrial fibrillation patients: An ancillary analysis from the BOREALIS trial

Bai, Ying, Shantsila, Alena ORCID: 0000-0002-0594-8576 and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2020) Clinical outcomes associated with kidney function changes in anticoagulated atrial fibrillation patients: An ancillary analysis from the BOREALIS trial. JOURNAL OF ARRHYTHMIA, 36 (2). pp. 282-288.

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Official URL: http://dx.doi.org/10.1002/joa3.12306

Abstract

<h4>Background</h4>Patients with atrial fibrillation (AF) and chronic kidney disease represent a high-risk group for thromboembolism and bleeding.<h4>Aims</h4>To explore the relationship between kidney function changes and outcomes of stroke/systemic embolism (SE), major bleeding and all-cause death in anticoagulated AF patients participating in the BOREALIS trial comparing efficacy and safety of once-weekly s.c. idrabiotaparinux to that of warfarin.<h4>Methods</h4>Changes in kidney function by estimated glomerular filtration rate (eGFR) were calculated using the Chronic Kidney Disease Epidemiology Collaboration equation in 2765 AF patients. Trial adjudicated outcomes were determined.<h4>Results</h4>After a mean follow-up of 394 days, in 94.4% of the included patients kidney function changed ranging from -30 mL/min to 30 mL/min. The incidence of stroke/SE and major bleeding was similar between patients with deteriorated (reduction in eGFR from baseline over follow-up) and preserved kidney function change (increase or no change in eGFR from baseline over follow-up) [stroke/SE: incidence rate (IR): 1.33%/year vs 1.80%/year; hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.41-1.32, <i>P</i> = .30; major bleeding: IR 1.63%/year vs 1.49%/year, HR 1.10, 95% CI 0.61-1.97, <i>P</i> = .76]. On Cox regression analysis, patients with deteriorated kidney function were at higher risk for all-cause death, compared to patients with preserved kidney function (HR: 1.64, 95% CI: 1.02-2.63, <i>P</i> = .04).<h4>Conclusion</h4>In the BOREALIS trial, the risk of adjudicated stroke/SE, major bleedings, and all-cause death was not related to mild-moderate follow-up changes in kidney function (±30 mL/min). The risk of all-cause death was significantly increased in AF patients with abruptly deteriorating kidney function.

Item Type:	Article
Uncontrolled Keywords:	deteriorated CKD-EPI eGFR change, major bleeding, all-cause death, preserved CKD-EPI eGFR change, stroke, systemic embolism
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	23 Jun 2021 10:17
Last Modified:	18 Jan 2023 22:33
DOI:	10.1002/joa3.12306
Open Access URL:	https://doi.org/10.1002/joa3.12306
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3127418