1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland
Background
Atrial fibrillation (AF) and chronic kidney disease (CKD) are often co-existing. However, CKD may independently increase the risk of AF patients for fatal outcomes such as stroke, myocardial infarction and major bleedings. Despite the impact and interaction between AF and CKD, populations of CKD patients are often underrepresented in studies and major randomized controlled trials (RCT).
Methods
This retrospective, single-center observational study uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB) where 10,222 AF patients between 2009-2020 were included who presented to the Chest Pain Unit of the University Hospital of Heidelberg. An estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m² was defined as CKD utilizing MDRD/CKD-EPI formula. A sequential follow-up was performed for all-cause mortality, stroke, major bleeding and myocardial infarction. This study was conducted according to ethical principles stated in the Declaration of Helsinki (2008).
Results
In a total of 10,222 included patients, 3889 patients (38%) had an eGFR <60 ml/min. Here, a total of 34% died, 3.8% developed a non-hemorrhagic stroke, 8.2% a major bleeding event according to ISTH major bleeding criteria and 6.2% developed a myocardial infarction during the median follow-up of 700 (IQR 367-1070) days. Stratified by the presence of CKD, log rank tests were significant for all-cause mortality (HR: 3.26 95%CI: 2.98-3.56, p<0.0001), stroke (HR: 1.58 95%CI: 1.23-2.02, p=0.0023), major bleeding (2.28 95%CI: 1.90-2.74, p<0.0001) and myocardial infarction (2.48, 95%CI: 2.00-3.10, p<0.0001).
Conclusions
The Findings from this sub study of HERA-FIB registry confirm the data from major RCTs for the relevance of CKD in AF patients in a clinical real-world setting.
Sources of funding
The study was supported by a research grant from Daiichi Sankyo and Bayer diagnostics. The sponsor had no influence on the study concept, data collection, or interpretation.