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Published on: February 26, 2013
Risk of Chronic Kidney Disease and Implications in Patients with Atrial Fibrillation for the Development of Major
Pedro Moltó-Balado1,2, Josep-Lluís Clua-Espuny3,4, Carlos Tarongi-Vidal5
1CSI Llíria, Departament de Salut de Arnau de Vilanova, Conselleria de Sanitat, 46160 Valencia, Spain.
Insights
Newly diagnosed atrial fibrillation (AF) significantly increases the risk of major adverse cardiovascular events (MACE). Kidney function measures like eGFR and albuminuria are crucial for risk stratification in AF patients.
Area of Science:
- Cardiology
- Nephrology
- Epidemiology
Background:
- Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, potentially exacerbating cardiovascular risk.
- The role of renal dysfunction in composite cardiovascular endpoints for AF patients requires clarification.
Purpose of the Study:
- To quantify the risk of MACE associated with AF.
- To assess the prognostic value of estimated glomerular filtration rate (eGFR) and albuminuria in AF patients.
- To inform composite outcome definitions and clinical management strategies.
Main Methods:
- Retrospective cohort study of 40,297 adults (65-95 years) with incident AF (n=2574) followed for 5 years.
- Analysis of MACE and its components using Cox models, stratified by eGFR and urine albumin-to-creatinine ratio (UACR).
- Exploratory machine learning model developed for MACE prediction in AF and CKD patients.
Main Results:
- Incident AF was linked to a 3.52-fold increased risk of MACE and a 1.97-fold increased risk of CKD.
- CKD prevalence was higher in AF patients (30.9%) vs. non-AF (14.5%).
- A graded relationship between reduced eGFR/increased UACR and MACE risk was observed in AF patients.
Conclusions:
- Newly diagnosed AF presents a significant excess risk for MACE and its components.
- eGFR and albuminuria are consistent predictors of risk in AF, supporting their inclusion in composite outcomes.
- Findings advocate for integrated cardiorenal management and refined risk stratification in AF care and research.
Background:
Atrial fibrillation (AF) and chronic kidney disease (CKD) often overlap and may amplify cardiovascular risk. Whether renal dysfunction should be incorporated into composite cardiovascular endpoints in AF remains uncertain. We aimed to quantify AF-associated risk of MACE and evaluate the incremental prognostic value of kidney measures (eGFR and albuminuria) to inform composite outcomes and clinical management.
Methods:
We performed a retrospective, community-based cohort study of 40,297 adults aged 65-95 years. Individuals with incident AF (n = 2574) were followed for 5 years. MACE and components were ascertained from linked health records; only events after AF diagnosis were analyzed. Cox models estimated adjusted hazard ratios (HRs). Risk was further stratified by eGFR stages and urine albumin-to-creatinine ratio (UACR) categories. Exploratory machine learning (ML) was developed to predict MACE in patients with AF and CKD, with model interpretability assessed by feature importance analysis.
Results:
Incident AF was associated with higher risk of MACE (HR 3.52), CKD (HR 1.97) and all-cause mortality (HR 1.14). CKD was nearly twice more frequent in AF than in non-AF (30.9% vs. 14.5%; p < 0.001). Among patients with AF, a graded eGFR-risk relationship was observed: compared with higher eGFR, MACE risk increased across G3a-G5, peaking in G5 (HR 2.08). Albuminuria showed a parallel gradient: versus UACR <30 mg/g, UACR 30-299 mg/g and ≥300 mg/g were associated with an increased risk of MACE (HR 1.51 and 1.76, respectively).
Conclusions:
Newly diagnosed AF confers a substantial excess risk of MACE and its components. The consistent eGFR and albuminuria in AF support considering clinically meaningful renal endpoints within composite outcomes and prioritizing integrated cardiorenal management. These findings provide actionable evidence to refine risk stratification and endpoint selection in AF research and care.
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