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Chronic kidney disease and atrial fibrillation: A dangerous combination

Gurbey Ocak1,2,3, Meriem Khairoun2, Othman Khairoun2

  • 1Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands.

Plos One
|April 7, 2022
PubMed

Insights

Chronic kidney disease (CKD) and atrial fibrillation (AF) significantly increase risks for bleeding, stroke, and mortality. A notable interaction between CKD and AF was found for ischemic stroke risk, highlighting a critical area for patient care.

Area of Science:

  • Cardiology
  • Nephrology
  • Epidemiology

Background:

  • Chronic kidney disease (CKD) and atrial fibrillation (AF) are independent risk factors for adverse cardiovascular outcomes.
  • Both conditions are prevalent and contribute to significant morbidity and mortality.
  • Understanding their combined impact is crucial for clinical risk stratification.

Purpose of the Study:

  • To investigate the interaction between CKD and AF on major adverse outcomes.
  • To quantify the combined risk of bleeding, ischemic stroke, and mortality in patients with both CKD and AF.
  • To determine if the risks associated with CKD and AF are additive or synergistic.

Main Methods:

  • A cohort study of 12,394 patients from the Utrecht Cardiovascular Cohort.
  • Cox proportional hazard analyses were used to calculate hazard ratios for adverse outcomes.
  • Interaction was assessed using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S).

Main Results:

  • Patients with both CKD and AF exhibited substantially increased risks for bleeding (3.0-fold), ischemic stroke (4.2-fold), and mortality (2.2-fold) compared to those without either condition.
  • A significant positive interaction between CKD and AF was identified for ischemic stroke risk (RERI 1.88, AP 0.45, S 2.40).
  • No significant interaction was found between CKD and AF for bleeding or mortality risks.

Conclusions:

  • While CKD and AF individually increase risks for bleeding, stroke, and mortality, their combined effect is particularly pronounced for ischemic stroke.
  • The findings suggest a synergistic relationship between CKD and AF specifically for ischemic stroke, warranting targeted preventive strategies.
  • Clinical management should consider the heightened risk of ischemic stroke in patients co-existing with both CKD and AF.
Abstract

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