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Published on: February 26, 2013
Comorbidity and Medication Trends in Chronic Kidney Disease and Incident Atrial Fibrillation: A Nationwide Cohort
Heini Jyrkilä1, Kati Kaartinen1, Leena Martola1
1Helsinki University Hospital, Abdominal Center, Department of Nephrology and University of Helsinki, Helsinki, Finland.
Insights
Over a quarter of patients with new-onset atrial fibrillation (AF) also have chronic kidney disease (CKD). Comorbidities and medication needs rise with declining kidney function, yet crucial treatments like lipid-lowering drugs are underused.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Chronic kidney disease (CKD) is a significant risk factor for developing atrial fibrillation (AF).
- Patients with AF face an elevated risk of adverse kidney outcomes.
- Understanding the interplay between CKD and AF is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence of comorbidities and medication use in patients diagnosed with both CKD and incident AF.
- To analyze how kidney function, measured by estimated glomerular filtration rate (eGFR), correlates with comorbidities and medication patterns.
- To identify potential gaps in the management of cardiovascular risk factors in this patient population.
Main Methods:
- Utilized the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) nationwide retrospective register-linkage study.
- Included 168,233 patients with incident AF from 2007-2018, with laboratory data available from 2010 onwards.
- Categorized patients into five CKD stages based on eGFR, including separate groups for dialysis and kidney transplant recipients.
Main Results:
- At AF diagnosis, 27% of patients had eGFR <60 mL/min/1.73 m2, indicating CKD stage 3-5.
- Lower eGFR was associated with a higher burden of comorbidities, including hypertension, dyslipidemia, and diabetes.
- Despite increasing prevalence of cardiovascular risk factors, the use of essential medications like lipid-lowering agents was suboptimal across all CKD stages.
Conclusions:
- More than one-fourth of patients with incident AF have co-existing CKD (stage 3-5).
- Comorbidity and medication complexity increase as kidney function declines.
- Optimal management of cardiovascular risk factors, particularly through appropriate medication use, requires greater attention in patients with CKD and AF.
Introduction:
Chronic kidney disease (CKD) is associated with an increased incidence of atrial fibrillation (AF). Also, patients with AF are prone to adverse kidney outcomes. We examined comorbidities and medication use in patients with CKD and incident AF.
Methods:
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide retrospective register-linkage study including data from 168,233 patients with incident AF from 2007 to 2018, with laboratory data from 2010 onwards. Estimated glomerular filtration rate (eGFR) was available for 124,936 patients. The cohort was divided into 5 CKD stages with separate groups for dialysis and kidney transplantation.
Results:
At AF diagnosis eGFR <60 mL/min/1.73 m2 was found in 27%, while 318 (0.3%) patients were on dialysis, and 188 (0.2%) had a functioning kidney transplant. Lowering eGFR yielded more comorbidities and medications. During 2010-2018 in patients with eGFR <60 mL/min/1.73 m2 prevalence of hypertension, dyslipidaemia, and diabetes increased from 82 to 88%, from 50 to 66% and from 25 to 33%, respectively (<0.001). Throughout the observation period, lipid-lowering medication was underused.
Conclusion:
More than one-fourth of patients with incident AF also had CKD stage 3-5 (eGFR <60 mL/min/1.73 m2). Both comorbidities and medication use increased with worsening kidney function. Prevalence of major cardiovascular (CV) risk factors increased during 2010-2018, but the use of survival-affecting medications, such as lipid-lowering medication, was suboptimal at all stages of CKD. More attention should be given to the optimal treatment of risk factors in this high CV risk population.
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