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Published on: February 26, 2013
Renal Dysfunction following Direct Current Cardioversion of Atrial Fibrillation: Incidence and Risk Factors
Nicolai Grüner-Hegge1, Danesh K Kella2, Deepak Padmanabhan2
1Cambridge University, Cambridge, United Kingdom.
Insights
Acute kidney injury (AKI) after direct current cardioversion (DCCV) for atrial fibrillation (AF) is common but usually self-limiting. Inpatient status, higher CHA2DS2-VASc score, diuretic use, and no chronic kidney disease increase AKI risk.
Area of Science:
- Nephrology
- Cardiology
Background:
- Emerging data link atrial fibrillation (AF) cardioversion to acute kidney injury (AKI).
- Limited data exist on AKI incidence and risk factors post-direct current cardioversion (DCCV) for AF.
Purpose of the Study:
- To determine the incidence and risk factors for AKI following DCCV in AF patients.
Main Methods:
- Prospective enrollment of AF patients undergoing DCCV at Mayo Clinic (2001-2012).
- AKI defined as ≥25% decline in eGFR within 7 days of DCCV, based on pre- and post-procedure serum creatinine.
- 1,256 patients with available SCR values formed the study cohort.
Main Results:
- 10.4% of patients developed AKI post-DCCV.
- Independent risk factors for AKI included inpatient status, higher CHA2DS2-VASc score, prior diuretic use, and absence of chronic kidney disease (CKD).
- AKI occurrence was independent of DCCV success and did not require acute dialysis.
Conclusions:
- AKI following DCCV for AF is a frequent complication.
- The condition is typically self-limited and does not necessitate renal replacement therapy.
Introduction:
Emerging data suggest that cardioversion for atrial fibrillation (AF) may be associated with acute kidney injury (AKI). However, limited data are available regarding the incidence and risk factors for AKI after direct current cardioversion (DCCV) of AF.
Methods:
All patients undergoing DCCV at Mayo Clinic between 2001 and 2012 for AF were prospectively enrolled in a database. All patients with serum creatinine (SCR) values pre- and post-cardioversion were reviewed for AKI, defined as a ≥25% decline in eGFR (estimated glomerular filtration rate) from baseline value within 7 days of the DCCV.
Results:
Of the 6,427 eligible patients, 1,256 (19.5%) patients had pre- and post-DCCV SCR available and formed the cohort under study. The mean age was 70.4 (SD 11.7) years, and 67.3% were male. During the study period, 131 (10.4%) patients suffered from AKI following DCCV. AKI was independently associated with inpatient status (OR 26.79; 95% CI 3.69-194.52), CHA2DS2-VASc score (OR 1.25; 95% CI 1.11-1.41), prior use of diuretics (OR 1.59; 95% CI 1.03-2.46), and absence of CKD (OR 1.61; 95% CI 1.04-2.49), and was independent of the success of the DCCV. None of the patients required acute dialysis during the study outcome period.
Conclusion:
AKI following DCCV of AF is common, self-limited, and without the need for replacement therapies.
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