Prevalence of renal dysfunction according to the type of atrial fibrillation and anticoagulation treatment in patients who attended primary care in Spain.

Abstract

To determine the prevalence of renal dysfunction according to the type of atrial fibrillation (AF) and anticoagulation treatment in patients attended in primary care in Spain. METHODS & PARTICIPANTS: The VAL-FAAP study was a national, descriptive, epidemiological and cross-sectional study that included patients of both sexes, ≥18 years of age, with a previous diagnosis of AF by an ECG, attended in a primary-care setting. Renal function was defined by estimated glomerular filtration rate (eGFR), calculated by the modification of diet in renal disease-4 formula. A total of 3287 patients with atrial fibrillation were included (mean age: 71.9 ± 10.1 years; 52.3% male). Overall, 31.6% of patients had an eGFR <60 ml/min/1.73m(2) and 1.6% <30 ml/min/1.73m(2). The proportion of patients with permanent AF increased as the eGFR decreased. Similarly, as congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke (doubled), vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) increased, chronic kidney disease was more frequent. A third of patients with CHA2DS2-VASc ≥2 had moderate renal dysfunction; however, 35.5% of them did not receive anticoagulants (compared with 31.5% of those with CHA2DS2-VASc ≥2 and normal renal function). Chronic kidney disease is common in patients with AF, particularly in those patients with permanent AF or CHA2DS2-VASc ≥2. Although indicated, 35.5% of patients with AF, a CHA2DS2-VASc ≥2 and moderate renal dysfunction did not receive appropriate anticoagulation, despite the high risk of stroke.