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Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation:
Francesco Violi1, Daniele Pastori1, Francesco Perticone2
1Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Rome, Italy.
Insights
In atrial fibrillation (AF) patients, a low Ankle-Brachial Index (ABI) is linked to faster kidney function decline. Measuring ABI can help identify AF patients at higher risk for worsening renal function.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Epidemiology
Background:
- Atrial fibrillation (AF) is associated with increased cardiovascular risk and potential renal complications.
- The Ankle-Brachial Index (ABI) is a marker of peripheral artery disease.
- The relationship between ABI and renal function in AF patients requires further investigation.
Purpose of the Study:
- To examine the association between baseline ABI and the progression of renal function in patients with AF.
- To identify predictors of rapid decline in estimated Glomerular Filtration Rate (eGFR) in this population.
Main Methods:
- An observational, prospective, multicentre cohort study involving 897 AF patients treated with vitamin K antagonists.
- Renal function was assessed by eGFR (CKD-EPI formula) at baseline and after 2 years.
- Primary endpoint was rapid eGFR decline (>5 mL/min/1.73 m²/year); secondary endpoint was incident eGFR <60 mL/min/1.73 m².
Main Results:
- A low ABI (≤0.90) was observed in 21.6% of patients.
- Low ABI (OR 1.516) and arterial hypertension (OR 1.830) independently predicted rapid eGFR decline.
- Low ABI (HR 1.851) was also an independent predictor for incident eGFR <60 mL/min/1.73 m².
Conclusions:
- In AF patients, a low ABI (≤0.90) is significantly associated with accelerated renal function decline.
- ABI measurement serves as a valuable tool for identifying AF patients at risk of kidney function deterioration.
Objective:
To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF).
Design:
Observational prospective multicentre cohort study.
Setting:
Atherothrombosis Center of I Clinica Medica of 'Sapienza' University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study.
Participants:
897 AF patients on treatment with vitamin K antagonists.
Main Outcome Measures:
The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m(2)/year, and incident eGFR<60 mL/min/1.73 m(2) were primary and secondary end points, respectively.
Results:
Mean age was 71.8±9.0 years and 41.8% were women. Low ABI (ie, ≤0.90) was present in 194 (21.6%) patients. Baseline median eGFR was 72.7 mL/min/1.73 m(2), and 28.7% patients had an eGFR<60 mL/min/1.73 m(2). Annual decline of eGFR was -2.0 (IQR -7.4/-0.4) mL/min/1.73 m(2)/year, and 32.4% patients had a rapid decline in eGFR. Multivariable logistic regression analysis showed that ABI ≤0.90 (OR 1.516 (95% CI 1.075 to 2.139), p=0.018) and arterial hypertension (OR 1.830 95% CI 1.113 to 3.009, p=0.017) predicted a rapid eGFR decline, with an inverse association for angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (OR 0.662 95% CI 0.464 to 0.944, p=0.023). Among the 639 patients with AF with eGFR >60 mL/min/1.73 m(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (HR 1.851, 95% CI 1.205 to 2.845, p=0.005).
Conclusions:
In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m(2). ABI measurement may help identify patients with AF at risk of renal function deterioration.
Trial Registration Number:
NCT01161251.
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