Faster eGFR Decline Predicts Worse Outcomes in CKD Patients with AF

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Longitudinal renal function trajectories may enable more individualized prediction of adverse outcomes, researchers conclude.
Longitudinal renal function trajectories may enable more individualized prediction of adverse outcomes, researchers conclude.

Faster kidney disease progression is associated with an increased risk of adverse outcomes in patients with both atrial fibrillation (AF) and chronic kidney disease (CKD), new data suggest.

In a study of 18,240 patients with AF and stage 3–4 CKD, each 1 mL/min/1.73 m2 per year decline in eGFR was associated with a significant 9% increased risk of major bleeding, 6% increased risk of hospitalization, and 11% increased risk of death from any cause, investigators led by Florian Posch, MD, of the Medical University of Graz in Graz, Austria, reported in the International Journal of Cardiology. Rate of eGFR decline was not associated with the risk of stroke or systemic embolism.

“Our results provide important insights into the clinical biology of kidney disease progression and adverse health outcomes in the setting of concomitant AF,” Dr Posch's team wrote. “They indicate that prospective longitudinal monitoring of kidney function (or a retrospective evaluation of longitudinally collected eGFR values from previous healthcare encounters) may represent a new avenue of personalized risk assessment with potential to improve the clinical management of elderly patients with comorbid AF and CKD.”

Patients had a median age of 80.4 years. At or before baseline, they had a median eGFR of 49 mL/min/1.73 m2. The study population was 55% female.

Although AF and CKD are known to be interdependent processes, “the association between longitudinal trajectories rather than single-point-in-time measurements of kidney function and adverse clinical outcomes have not been explored before,” the authors wrote.

Reference

Posch F, Ay C, Stöger H, et al. Longitudinal kidney function trajectories predict major bleeding, hospitalization and death in patients with atrial fibrillation and chronic kidney disease. Int J Cardiol. 2019; published online ahead of print.

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