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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cause-Specific Mortality in Patients with Chronic Kidney Disease and Atrial Fibrillation
Medha Airy1, Jesse D Schold2,3, Stacey E Jolly4
1Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Insights
Atrial fibrillation (AF) increases mortality risk in chronic kidney disease (CKD) patients. This study found AF linked to higher overall and cardiovascular death rates, but a lower risk of cancer mortality in CKD individuals.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Atrial fibrillation (AF) is a known risk factor for mortality in patients with chronic kidney disease (CKD).
- Understanding the specific causes of death associated with AF in CKD is crucial for patient management.
Purpose of the Study:
- To investigate the association between atrial fibrillation (AF) and cause-specific mortality in a large cohort of patients with chronic kidney disease (CKD).
Main Methods:
- A cohort of 62,459 patients with CKD (estimated glomerular filtration rate 15-59 mL/min/1.73 m2) was analyzed, including 6,639 with AF.
- Cox regression and competing risk models were employed to assess associations between AF and overall, cardiovascular, malignancy, and other causes of death.
- Adjustments were made for demographics, comorbidities, laboratory data, medication use, and kidney function.
Main Results:
- During a median follow-up of 4.1 years, AF was associated with a 23% higher risk of all-cause mortality and a 45% higher risk of cardiovascular mortality.
- AF was also linked to a 13% lower risk of malignancy-related mortality.
- These associations remained consistent across different stages of CKD.
Conclusions:
- In non-dialysis-dependent CKD patients, AF is associated with increased all-cause and cardiovascular mortality.
- Clinical practice and research should focus on mitigating the elevated cardiovascular risk in patients with both CKD and AF.
Background:
Atrial fibrillation (AF) is associated with death in patients with chronic kidney disease (CKD). We examined the associations between AF and cause-specific mortality in a large CKD population.
Methods:
We included 62,459 patients with estimated glomerular filtration rate 15-59 mL/min/1.73 m2 (6,639 patients with AF and 55,820 without AF) followed in a large health care system. Outcomes included overall and cause-specific deaths (a) cardiovascular; (b) malignancy; and (c) non-cardiovascular/non-malignancy causes. Cox regression models for overall mortality and separate competing risk models for each major cause of death category were used to evaluate their respective associations with AF.
Results:
During a median follow-up of 4.1 years, 19,094 patients died; cause of death was known for 18,854 patients. After multivariable adjustment (demographics, comorbidities, relevant laboratory data, medication use, and kidney function), AF was associated with 23% (95% CI 18-29%) higher risk of all-cause mortality, 45% (95% CI 31-61%) higher risk of cardiovascular mortality and 13% (95% CI 3-22%) lower risk of malignancy-related mortality. Exclusion of patients with malignancy yielded similar results except for a lack of association between AF and malignancy-related deaths. Results were consistent across various stages of CKD.
Conclusions:
In a non-dialysis-dependent CKD population, the presence of AF was associated with higher all-cause and cardiovascular mortality. These data suggest that patients with both CKD and AF are at high cardiovascular risk, and thus clinical practice (or trials) should aim at reducing the overall excess cardiovascular mortality (not stroke alone) in patients with AF and CKD.
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