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

the ESC-EHRA EORP-AF Long-Term General Registry Investigators

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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.

Original languageEnglish
Article numbere13745
JournalEuropean Journal of Clinical Investigation
Volume52
Issue number6
DOIs
Publication statusPublished - 1 Jun 2022

Bibliographical note

Funding Information:
Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), Vifor (2019–2022). EORP Oversight Committee, Executive and Steering Committees (National Coordinators) of the EURObservational Research Programme (EORP) – Atrial Fibrillation General Long-Term (EORP-AFGen LT) Registry of the European Society of Cardiology (ESC). Data collection was conducted by the EORP department by Patti-Ann McNeill as Project Officer, Viviane Missiamenou as Data Manager. Overall activities were coordinated and supervised by Doctor Aldo P. Maggioni (EORP Scientific Coordinator).

Funding Information:
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.

Publisher Copyright:
© 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

Other keywords

  • atrial fibrillation
  • chronic kidney disease
  • death
  • kidney failure
  • major bleeding
  • outcome
  • thromboembolism

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