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Published on: February 26, 2013
[Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in
M I Chashkina1, N L Kozlovskaya2, D A Andreev3
1First Sechenov Moscow State Medical University under Ministry of Health.
Insights
A significant portion of atrial fibrillation patients have chronic kidney disease (CKD) or reduced GFR, impacting anticoagulant therapy choices. Dosing of anticoagulants was frequently not adjusted for GFR in these high-risk patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) is frequently comorbid with chronic kidney disease (CKD).
- Reduced glomerular filtration rate (GFR) significantly impacts cardiovascular health and treatment strategies in AF patients.
- Understanding the prevalence of CKD stages and GFR reduction in AF is crucial for optimizing anticoagulant therapy.
Purpose of the Study:
- To determine the prevalence of CKD stages 3b-5 and newly diagnosed sustained GFR reduction (<30 ml/min/1.73 m2) in patients with AF.
- To analyze the characteristics of anticoagulant therapy prescribed to these patients in real-world clinical practice.
- To identify potential discrepancies in anticoagulant dosing based on GFR levels.
Main Methods:
- Retrospective analysis of discharge records from five Moscow hospitals (June 2016 - May 2017).
- Inclusion of adult patients diagnosed with AF.
- Selection of patients with CKD stages 3b-5 or newly diagnosed sustained GFR reduction (<30 ml/min/1.73 m2) based on at least two measurements during hospitalization.
Main Results:
- Out of 9725 patients, 2983 (31%) had AF. Of these, 794 (27%) had GFR <45 ml/min/1.73 m2.
- Among patients with reduced GFR, 349 (44%) had CKD 3b, 123 (15%) CKD 4, 44 (6%) CKD 5, and 278 (35%) had newly diagnosed sustained GFR reduction.
- Anemia was prevalent (63%) in AF patients with GFR <45 ml/min/1.73 m2. 89% received anticoagulants, with 53% on direct oral anticoagulants (DOACs).
- Specific anticoagulant choices varied by CKD stage, with warfarin more common in advanced CKD and rivaroxaban/apixaban in earlier stages or newly diagnosed GFR reduction.
- Crucially, anticoagulant doses were often not adjusted according to GFR in patients with newly diagnosed sustained GFR reduction <30 ml/min/1.73 m2.
Conclusions:
- A quarter of AF patients exhibit reduced GFR (<45 ml/min/1.73 m2), with half recommended DOACs.
- For those with GFR <30 ml/min/1.73 m2, DOACs were prescribed in 42% and warfarin in 27%.
- DOACs were not prescribed for CKD 5 patients, and half received no anticoagulation.
- A significant proportion of patients with newly diagnosed sustained GFR reduction <30 ml/min/1.73 m2 did not have their anticoagulant doses adjusted for GFR, highlighting a potential gap in management.
Objective:
To estimate the prevalence of chronic kidney disease (CKD) 3b - 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy.
Materials And Methods:
Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b - 5 st and newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected.
Results:
Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 - warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 - apixaban 10 mg / day (16.2 %).
Conclusion:
A quarter of patients with AF revealed a decreased GFR <45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml / min / 1.72 m2 were prescribed DOACs, 27 % - warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2.
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