Kidney Week

Abstract: FR-OR017

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

Session Information

• CKD-CV Axis: Epidemiology and Outcomes
  November 03, 2017 | Location: Room 262, Morial Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: Chronic Kidney Disease (Non-Dialysis)

• 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

• Massicotte-Azarniouch, David, University of Ottawa, Ottawa, Ontario, Canada

David Massicotte-Azarniouch, MD

• Kuwornu, John Paul, Institute for Clinical Evaluative Sciences, London, Ontario, Canada

John Paul Kuwornu,

• Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden

Juan Jesus Carrero,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Molnar, Amber O., McMaster University, Hamilton, Ontario, Canada

Amber O. Molnar,

• Zimmerman, Deborah Lynn, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Deborah Lynn Zimmerman,

• Mccallum, Megan K., Institute for Clinical Evaluative Sciences, London, Ontario, Canada

Megan K. Mccallum,

• Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada

Ron Wald,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Manish M. Sood,

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.