Renal function and mortality in patients with atrial fibrillation

Area of Science:

• Cardiology
• Nephrology
• Public Health

Background:

• Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular risk.
• Chronic kidney disease (CKD) is a prevalent comorbidity in AF patients, potentially exacerbating adverse outcomes.
• The impact of CKD and varying estimated glomerular filtration rate (eGFR) on mortality in AF requires further investigation.

Purpose of the Study:

• To investigate the association between the presence and stages of CKD and eGFR levels with all-cause and cardiovascular mortality in hospitalized AF patients.

Main Methods:

• A posthoc analysis of a randomized controlled trial involving hospitalized AF patients.
• Utilized Kaplan-Meier curves, multivariate Cox-regression, and spline curve analyses for outcome assessment.
• Assessed CKD presence, CKD stages (2-5), and eGFR continuum against mortality endpoints.

Main Results:

• 43.7% of 1064 AF patients had CKD, associated with increased all-cause (aHR: 1.60) and cardiovascular mortality (aHR: 1.74).
• All-cause mortality risk escalated with CKD stages 2-5 compared to stage 1 (aHRs: 2.18-4.20).
• eGFR values below 50 mL/min/1.73 m² independently predicted higher mortality.

Conclusions:

• CKD is an independent predictor of decreased survival in recently hospitalized AF patients, with risks increasing across stages 2-5.
• Lower eGFR (<50 mL/min/1.73 m²) is incrementally associated with worse prognosis in this cohort.
• These findings underscore the importance of assessing renal function in AF management to mitigate mortality risk.