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Mild kidney disease as a risk factor for major bleeding in patients with atrial fibrillation undergoing percutaneous

Sergio Manzano-Fernández1, Francisco Cambronero, Cesar Caro-Martínez

  • 1Sergio Manzano-Fernández, MD, PhD, Cardiology Department, University Hospital Virgen de la Arrixaca, C/ Madrid-Cartagena. s/n. CP 30120, Murcia, Spain, Tel.: +34 968399445, Fax: +34 968369662,

Thrombosis and Haemostasis
|November 11, 2011
PubMed

Insights

Mild kidney disease (KD) significantly increases major bleeding risk in atrial fibrillation (AF) patients undergoing PCI-S. This finding highlights the need to consider mild KD in bleeding risk assessments for AF patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Research

Background:

  • Patients with atrial fibrillation (AF) and moderate to severe kidney disease (KD) face increased bleeding risks.
  • The impact of mild KD on bleeding complications in AF patients undergoing percutaneous coronary intervention with stent implantation (PCI-S) remains unclear.

Purpose of the Study:

  • To investigate whether mild KD elevates the risk of major bleeding (MB) in AF patients undergoing PCI-S.
  • To analyze the association between different stages of KD and MB risk in this patient cohort.

Main Methods:

  • A cohort of 285 AF patients undergoing PCI-S was classified into three groups: moderate to severe KD (<60 ml/min/1.73 m²), mild KD (60-89 ml/min/1.73 m²), and non-KD (≥90 ml/min/1.73 m²).
  • Estimated glomerular filtration rate (eGFR) was calculated using the simplified Modification of Diet in Renal Disease (MDRD) equation.
  • Patients were followed for one year to record MB events.

Main Results:

  • Overall, 9.8% of patients experienced MB.
  • A significant graded increase in MB risk was observed with worsening renal function: non-KD (1.8%), mild KD (7.9%), and moderate to severe KD (17.6%) (p <0.001).
  • Mild KD was independently associated with a 2.43-fold increased risk of MB compared to non-KD patients (p=0.039).
  • Additional MB predictors included moderate-severe KD, anemia, and triple antithrombotic therapy post-PCI-S.

Conclusions:

  • Mild KD significantly increases the risk of major bleeding complications in AF patients undergoing PCI-S.
  • Current bleeding risk stratification tools may underestimate risk in patients with mild KD.
  • Further research should explore incorporating mild KD status into bleeding risk assessment models for improved patient management.

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