Abstract
We assessed 1-year outcomes in patients with atrial fibrillation enrolled in the EurObservational Research Programme AF General Pilot Registry (EORP-AF), in relation to kidney function, as assessed by glomerular filtration rate (eGFR). In a cohort of 2398 patients (median age 69 years; 61% male), eGFR (ml/min/1.73 m2) calculated using the CKD-EPI formula was ≥80 in 35.1%, 50–79 in 47.2%, 30–49 in 13.9% and <30 in 3.7% of patients. In a logistic regression analysis, eGFR category was an independent predictor of stroke/TIA or death, with elevated odds ratios associated with severe to mild renal impairment, ie. eGFR < 30 ml/min/1.73 m2 [OR 3.641, 95% CI 1.572–8.433, p < 0.0001], 30–49 ml/min/1.73 m2 [OR 3.303, 95% CI 1.740–6.270, p = 0.0026] or 50–79 ml/min/1.73 m2 [OR 2.094, 95% CI 1.194–3.672, p = 0.0003]. The discriminant capability for the risk of death was tested among various eGFR calculation algorithms: the best was the Cockcroft-Gault equation adjusted for BSA, followed by Cockcroft-Gault equation, and CKD-EPI equation, while the worst was the MDRD equation. In conclusion in this prospective observational registry, renal function was a major determinant of adverse outcomes at 1 year, and even mild or moderate renal impairments were associated with an increased risk of stroke/TIA/death.
Highlights
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its incidence and prevalence are increasing worldwide[1]
The objective of this report from the EURObservational Research Programme – Atrial Fibrillation (EORP-AF) General Pilot Registry was to investigate the baseline characteristics and the outcomes at 1 year follow-up of prospectively enrolled AF patients presenting to cardiologists, in relation to kidney function, as assessed by different equations for estimated glomerular filtration rate and 1-year outcomes, in terms of stroke and mortality in European AF patients followed by cardiologists
According to AUCs of the ROC curves, the best discriminant capability for death prediction according to estimated GFR (eGFR) categories was found for the Cockcroft-Gault equation adjusted for BSA (p < 0.0001 vs. MDRD equation and p = 0.0238 vs. Chronic kidney disease (CKD)-EPI equation), followed by Cockcroft-Gault equation (p = 0.0002 vs. MDRD equation and p = 0.0676 vs. CKD-EPI equation), and CKD-EPI equation (p = 0.0023), while the worst was found for the MDRD equation (Fig. 3)
Summary
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its incidence and prevalence are increasing worldwide[1]. Clinical Practice Guidelines delivered by KDIGO (Kidney Disease: Improving Global Outcomes) group for the evaluation and management of CKD recommended, in 2012, use of the CKD EPI equation for estimation of eGFR, on the basis of standardized serum www.nature.com/scientificreports/. Creatinine, and for staging of kidney function impairment[2,9] This recommendation is not concordant with the advice to use Cockcroft-Gault equation for evaluating kidney function for the prescription of NOACs in cardiology practice[8]. The objective of this report from the EURObservational Research Programme – Atrial Fibrillation (EORP-AF) General Pilot Registry was to investigate the baseline characteristics and the outcomes at 1 year follow-up of prospectively enrolled AF patients presenting to cardiologists, in relation to kidney function, as assessed by different equations for estimated glomerular filtration rate (eGFR) and 1-year outcomes, in terms of stroke and mortality in European AF patients followed by cardiologists. The analysis had the aim to assess the concordance between the different equations proposed for estimating GFR and the potential differences in terms of outcome prediction
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