Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Ding, Wern Yew ORCID: 0000-0003-3596-6545, Potpara, Tatjana S, Blomstrom-Lundqvist, Carina, Boriani, Giuseppe, Marin, Francisco, Fauchier, Laurent, Lip, Gregory YH and Reg, ESC-EHRAEORP-AF Long-Term Gen (2022) Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry. EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 52 (6). e13745-.

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Official URL: http://dx.doi.org/10.1111/eci.13745

Abstract

<h4>Background</h4>Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF.<h4>Methods</h4>We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission.<h4>Results</h4>A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p < .001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01-1.14] per 10 ml/min/1.73 m<sup>2</sup> decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m<sup>2</sup> (HR 2.21 [95% CI, 1.23-3.99] compared to eGFR ≥90 ml/min/1.73 m<sup>2</sup> ).<h4>Conclusion</h4>A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF.

Item Type:	Article
Uncontrolled Keywords:	atrial fibrillation, chronic kidney disease, death, kidney failure, major bleeding, outcome, thromboembolism
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:	27 Jan 2022 11:06
Last Modified:	18 Jan 2023 21:14
DOI:	10.1111/eci.13745
Open Access URL:	https://doi.org/10.1111/eci.13745
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3147689