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. 2022 Jun;52(6):e13745.
doi: 10.1111/eci.13745. Epub 2022 Jan 17.

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

Wern Yew Ding  1 , Tatjana S Potpara  2   3 , Carina Blomström-Lundqvist  4 , Giuseppe Boriani  5 , Francisco Marin  6 , Laurent Fauchier  7 , Gregory Y H Lip  1   8 ; ESC-EHRA EORP-AF Long-Term General Registry Investigators
Collaborators, Affiliations

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

Wern Yew Ding et al. Eur J Clin Invest. 2022 Jun.

Abstract

Background: 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.

Methods: 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.

Results: 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 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23-3.99] compared to eGFR ≥90 ml/min/1.73 m2 ).

Conclusion: 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.

Keywords: atrial fibrillation; chronic kidney disease; death; kidney failure; major bleeding; outcome; thromboembolism.

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Conflict of interest statement

GB: small speaker's fees from Medtronic, Boston, Biotronik, Boehringer and Bayer, outside of the submitted work. FM: receiving grants from Ferrer, and personal fees from Bayer, Pfizer/BMS. Boehringer‐Ingelheim and Astra‐Zeneca outside the submitted work. CBL: receiving grants from Medtronic, Cardiome and personal fees from Bayer, Sanofi, Boston Scientific and Merck Sharp & Dohme outside the submitted work. TSP: Consultant for Bayer and Pfizer, no fees. LF: consultant or speaker fees of small amounts for Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic and Novartis outside of this work. GYHL: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi‐Sankyo. No fees are received personally. Other authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Antithrombotic regime in patients with a valid indication at baseline according to renal function. VKA, vitamin K antagonist; NOAC, non‐vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant
FIGURE 2
FIGURE 2
Kaplan–Meier curves for the composite outcome of thromboembolism, major bleeding, acute coronary syndrome and all‐cause death (A), thromboembolism (B), major bleeding (C) and all‐cause death (D) according to renal function. No renal impairment is represented by dark blue, mild renal impairment by light blue, moderate renal impairment by green and severe renal impairment by red
FIGURE 3
FIGURE 3
Multivariable Cox regression analysis for independent predictors of the composite outcome of thromboembolism, major bleeding, acute coronary syndrome and all‐cause death with eGFR as a categorical (A) and continuous (B) covariate. Dashes represent hazard ratio and line edges represent limits of 95% confidence intervals. BMI, body mass index, CI, confidence intervals; COPD, chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LA, left atrial; LV EF, left ventricular ejection fraction; NOAC, non‐vitamin K antagonist oral anticoagulant
See this image and copyright information in PMC

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