Abstract: FR-OR017

Incident Atrial Fibrillation and the Risk of Subsequent Adverse Outcomes in Patients with a Decreased eGFR

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Massicotte-Azarniouch, David, University of Ottawa, Ottawa, Ontario, Canada
  • Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Kuwornu, John Paul, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden
  • Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada
  • Molnar, Amber O., McMaster University, Hamilton, Ontario, Canada
  • Zimmerman, Deborah Lynn, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Mccallum, Megan K., Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
Background

The effect of atrial fibrillation (AF) among patients with decreases in eGFR and its subsequent effect on adverse outcomes remain unknown.

Methods

In this population-based retrospective cohort study, we determined the association of AF with congestive heart failure (CHF), myocardial infarction (MI), end stage kidney disease (ESKD) and all-cause mortality in patients with reduced renal function. Among 1,422,978 million adult residents with an eGFR measure < 90 ml/min/1.73m2, we identified 93,414 with AF. We used propensity-score matched, competing risk models to determine the risk of CHF, MI and ESKD accounting for the competing risk of mortality. The eGFR level was examined using interaction terms for each adverse outcome.

Results

All adverse events were more frequent in individuals with atrial fibrillation compared to no atrial fibrillation [CHF: AF 9.9% vs. No AF 3.1%, HR 3.88 (95% confidence interval, CI 3.69-4.07)], [ESKD: AF 0.7% vs. No AF 0.4%, HR 2.10 (95%CI 1.89-2.32)], [MI: AF 3.2% vs. No AF 2.0%, HR 1.60(95% CI 1.54-1.67)], [all-cause mortality: AF 21.7% vs. No AF 17.6%, HR 1.32 (95%CI 1.29-1.35)]. The eGFR level was an effect modifier for all outcomes (p<0.05 for eGFR X outcome interaction). The risk of CHF, MI and ESKD were highest within the first 6 months of AF onset.

Conclusion

Incident AF is associated with a high risk of adverse outcomes in patients with an eGFR < 90ml/min/1.73m2 and the risk differs by eGFR level. As the risk is highest within the first 6 months after AF diagnosis, therapeutic interventions and monitoring may improve outcomes.

Funding

  • Government Support - Non-U.S.