Chronic kidney disease and risks of adverse clinical events in patients with atrial fibrillation
Si-Tong LI1
Chao JIANG1
Liu HE1
Qi-Fan LI1
Zuohan DING2
Jia-Hui WU1
Rong HU1
Qiang LV1
Xu LI1
Chang-Qi JIA1
Yan-Fei RUAN1
Man NING1
Li FENG1
Rong BAI1
Ri-Bo TANG1
Xin DU3
Jian-Zeng DONG1
Chang-Sheng MA1
1.Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University and National Clinical Research Center for Cardiovascular Diseases,Beijing,China2.University of Edinburgh,Edinburgh,UK3.Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University and National Clinical Research Center for Cardiovascular Diseases,Beijing,China;Heart Health Research Centre,Beijing,China
摘要：BACKGROUND Chronic kidney disease (CKD) is highly prevalent in patients with atrial fibrillation (AF). However, the asso-ciation between CKD and clinical consequences in AF patients is still under debate.METHODS We included 19,079 nonvalvular AF patients with available estimated glomerular filtration rate (eGFR) values in the Chinese Atrial Fibrillation Registry from 2011 to 2018. Patients were classified into no CKD (eGFR ≥ 90 mL/min per 1.73 m2), mild CKD (60 ≤ eGFR < 90 mL/min per 1.73 m2), moderate CKD (30 ≤ eGFR < 60 mL/min per 1.73 m2), and severe CKD (eGFR <30 mL/min per 1.73 m2) groups. The risks of thromboembolism, major bleeding, and cardiovascular mortality were estimated with Fine-Gray regression analysis according to CKD status. Cox regression was performed to assess the risk of all-cause mortal-ity associated with CKD. RESULTS Over a mean follow-up of 4.1 ± 1.9 years, there were 985 thromboembolic events, 414 major bleeding events, 956 car-diovascular deaths, and 1,786 all-cause deaths. After multivariate adjustment, CKD was not an independent risk factor of throm-boembolic events. As compared to patients with no CKD, those with mild CKD, moderate CKD, and severe CKD had a 45％, 47％, and 133％ higher risk of major bleeding, respectively. There was a graded increased risk of cardiovascular mortality associated with CKD status compared with no CKD group: adjusted hazard ratio [HR] was 1.34 (95％ CI: 1.07?1.68, P = 0.011) for mild CKD group, 2.17 (95％ CI: 1.67?2.81, P < 0.0001) for moderate CKD group, and 2.95 (95％ CI: 1.97?4.41, P < 0.0001) for severe CKD group, respectively. Risk of all-cause mortality also increased among patients with moderate or severe CKD. CONCLUSIONS CKD status was independently associated with progressively higher risks of major bleeding and mortality, but didn't seem to be an independent predictor of thromboembolism in AF patients.
机标关键词：clinicalkidneyriskswithadverseatrialchronicdisease
论文发表日期：2021-11-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：10( 867-876 )