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Updated: Jan 16, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
The Prognostic Interplay of Heart Failure and Chronic Kidney Disease in Atrial Fibrillation: Focus on Cardiorenal
Ulrike Baumer1, Lea Pedarnig1, Andreas Hammer1
1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Insights
Heart failure (HF) and chronic kidney disease (CKD) significantly worsen cardiorenal outcomes in atrial fibrillation (AF) patients. Early risk assessment for AF should include HF and CKD to predict cardiovascular death, heart failure hospitalizations, and renal death.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Heart failure (HF) and chronic kidney disease (CKD) create a detrimental cycle, increasing disease severity and mortality.
- Both HF and CKD are common in atrial fibrillation (AF) patients, worsening symptoms and outcomes.
- The interplay between HF, CKD, and AF necessitates investigation into cardiorenal outcomes.
Purpose of the Study:
- To investigate the relationship between heart failure (HF) and chronic kidney disease (CKD) with cardiorenal outcomes in patients with atrial fibrillation (AF).
Main Methods:
- A cohort of 7,412 AF patients treated at a tertiary center from 2005-2019 was analyzed.
- The primary endpoint was a composite of cardiovascular (CV) death and hospitalization for HF (HHF).
- Secondary outcomes included all-cause death, renal death, and dialysis.
Main Results:
- A significant, stepwise increase in 5-year event rates for CV death/HHF was observed with increasing severity of HF and CKD.
- Both CKD (aHR: 1.87) and HF (aHR: 2.57) were independently associated with increased risk of CV death/HHF.
- Similar associations were found for individual endpoint components and renal death/dialysis.
Conclusions:
- CKD and HF significantly elevate the risk of CV death, HHF, and renal death/dialysis in AF patients.
- Risk assessment in AF should extend beyond stroke and bleeding to include cardiorenal complications.
- Comprehensive evaluation of cardiorenal complications is crucial for managing AF patients with comorbidities.
Abstract:
Background: Heart failure (HF) and chronic kidney disease (CKD) create a mutually reinforcing cycle, escalating disease development, and increasing morbidity and mortality rates. Both are common comorbidities promoting AF and contributing to heightened symptom burden and poorer outcomes in AF. Here our aim was to investigate the relationship of HF and CKD with cardiorenal outcomes in patients with atrial fibrillation (AF).
Methods:
Patients with AF, treated at a tertiary centre between January 2005 and July 2019, were included. The primary endpoint was a composite of cardiovascular (CV) death and hospitalization for HF (HHF). Secondary outcomes were the individual components of the primary endpoint, all-cause death, renal death, and dialysis.
Results:
We included a total of 7,412 patients (median age 70 years, 39.7% female) with AF and followed them over a median of 4.5 years. There was a significant stepwise increase in 5-year event rates for the composite of CV death/HHF (no CKD and no HF: 23%, HF: 61%, CKD: 63%, CKD and HF: 82%; P log-rank <0.001). Both CKD (adjusted hazard ratio [HR]: 1.87, 95% confidence interval [CI]: 1.55-2.25) and HF (adjusted HR: 2.57, 95% CI: 2.22-2.98) were significantly associated with CV death/HHF after multivariable adjustment. A similar association was observed for the individual components of the primary endpoint and renal death/dialysis.
Conclusions:
Both CKD and HF significantly increase the risk of CV death and HHF, as well as renal death/dialysis in patients with AF. Risk assessment should expand beyond stroke and bleeding to cardiorenal complications including HHF, CV, and renal death, as well as kidney failure.
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