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. 2016 Jun:8:309-316.
doi: 10.1016/j.ebiom.2016.04.013. Epub 2016 Apr 19.

Chronic Kidney Disease, Time in Therapeutic Range and Adverse Clinical Outcomes in Anticoagulated Patients with Non-valvular Atrial Fibrillation: Observations from the SPORTIF Trials

Marco Proietti  1 , Deirdre A Lane  1 , Gregory Y H Lip  2
Affiliations

Chronic Kidney Disease, Time in Therapeutic Range and Adverse Clinical Outcomes in Anticoagulated Patients with Non-valvular Atrial Fibrillation: Observations from the SPORTIF Trials

Marco Proietti et al. EBioMedicine. 2016 Jun.

Abstract

Background: Chronic kidney disease (CKD) is highly prevalent in atrial fibrillation (AF) patients and associated with an increased risk of adverse outcomes. Our objectives were to study clinical features associated with CKD in AF patients and the impact of CKD on anticoagulation control, as reflected by time in therapeutic range (TTR). We also determined the impact of CKD and TTR in predicting adverse outcomes.

Methods and results: We analysed pooled datasets from SPORTIF III and V trials, including 3646 patients assigned to warfarin with data on renal function. CKD (creatinine clearance <60ml/min) was present in 952 (26%) patients. TTR was higher in patients with normal renal function compared to those with CKD (p<0.001). On logistic analysis, chronic AF and male sex were associated with TTR>70%, whilst diabetes mellitus, aspirin use and CKD were inversely associated with TTR>70%. On Cox regression analysis, CKD was an independent predictor for stroke (p=0.006) and death (p<0.001). TTR>70% was independently associated with a lower risk of stroke (p=0.024), death (p=0.001) and major bleeding (p=0.001).

Conclusions: CKD is highly prevalent amongst AF patients and a risk factor for stroke and death. Adjusting for CKD, good quality anticoagulation control (TTR>70%) was an independent predictor for lower risks of stroke, death and major bleeding.

Keywords: Chronic kidney disease; Clinical outcomes; Major bleeding; Non-valvular atrial fibrillation; Stroke.

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Figures

Fig. 1
Fig. 1
Patients included in this analysis.
Fig. 2
Fig. 2
Scatterplot and regression line between creatinine clearance and TTR Legend = TTR: time in therapeutic range.
Fig. 3
Fig. 3
Cumulative event-free survival in patients according to the presence of chronic kidney disease. Panel A) Stroke p = 0.001; Panel B) Major bleeding p = 0.002; Panel C) Death p < 0.001. Legend = Solid line: normal renal function; dashed line: CKD.
Fig. 4
Fig. 4
Correlation between TTR and hazard risk according to presence of chronic kidney disease. Panel A) Stroke p < 0.001; Panel B) Major bleeding p < 0.001; Panel C) Death p < 0.001. Legend = Cross and solid line: normal renal function; square and dashed line: CKD.
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References

    1. Albers G.W., Diener H.-C., Frison L., Grind M., Nevinson M., Partridge S., Halperin J.L., Horrow J., Olsson S.B., Petersen P., Vahanian A. Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial. JAMA. 2005;293:690–698. - PubMed
    1. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratificationAm. J. Kidney Dis. 2002;39:S1–266. - PubMed
    1. Apostolakis S., Guo Y., Lane D.A., Buller H., Lip G.Y.H. Renal function and outcomes in anticoagulated patients with non-valvular atrial fibrillation: the AMADEUS trial. Eur. Heart J. 2013;34:3572–3579. - PubMed
    1. Banerjee A., Fauchier L., Vourc’h P., Andres C.R., Taillandier S., Halimi J.M., Lip G.Y.H. Renal impairment and ischemic stroke risk assessment in patients with atrial fibrillation: the Loire Valley atrial fibrillation project. J. Am. Coll. Cardiol. 2013;61:2079–2087. - PubMed
    1. Banerjee A., Fauchier L., Vourc'h P., Andres C.R., Taillandier S., Halimi J.M., Lip G.Y.H. A prospective study of estimated glomerular filtration rate and outcomes in patients with atrial fibrillation: the Loire Valley atrial fibrillation project. Chest. 2014;145:1370–1382. - PubMed

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