Different Renal Function Estimation Formulas for Adverse Outcomes in Patients with Atrial Fibrillation Receiving...

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• The Cockcroft-Gault (CG) formula is the standard for renal function assessment in atrial fibrillation (AF) patients using direct oral anticoagulants (DOACs).
• Alternative renal function estimation formulas exist but their comparative performance is less understood.

Purpose of the Study:

• To compare the agreement and predictive accuracy of various renal function formulas.
• To evaluate the performance of these formulas in predicting clinical outcomes for AF patients on DOAC therapy.

Main Methods:

• Retrospective analysis of 21,318 non-valvular AF patients on DOACs from a Taiwanese multicenter database (June 2012-December 2021).
• Renal function estimated using eight formulas: CG, CG-BSA, MDRD, CKD-EPI, JSN-CKDI, FAS, LMR, and EKFC.
• Concordance assessed via weighted Cohen's Kappa; predictive performance evaluated using Cox regression, ROC curves, and Harrell's C-index for composite outcomes (thromboembolism, mortality, major bleeding).

Main Results:

• Most patients had normal renal function (≥60 ml/min) across formulas, varying from 25.7% (JSN-CKDI) to 65.3% (CKD-EPI).
• Moderate concordance observed between CG and MDRD (K=0.512) or CKD-EPI (K=0.481).
• Adverse outcomes increased exponentially below 60 ml/min. The CG formula (AUC:0.707) showed superior predictive performance for adverse events compared to MDRD (AUC:0.641) and CKD-EPI (AUC:0.664).

Conclusions:

• The CG formula is essential for managing Asian AF patients treated with DOACs.
• It plays a vital role in both medication dosing and predicting adverse clinical events in this population.