Abstract: FR-OR011

The Risk of Stroke with Atrial Fibrillation in CKD Patients

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada
  • Mccallum, Megan K., Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Molnar, Amber O., McMaster University, Hamilton, Ontario, Canada
Background

Both atrial fibrillation (AF) and chronic kidney disease (CKD) are known to increase the risk of ischemic and hemorrhagic stroke. However the relative contribution of albuminuria and eGFR level on stroke risk in patients with and without AF remains unknown.

Methods

From a total cohort of 736,666 patients from Ontario, Canada from 2002-2015, 35024 patients developed incident AF with an ACR and eGFR measure within 12 months prior. AF and stroke were determined by hospital diagnostic codes at admission. We used propensity-score matched Cox proportional and Fine and Grey sub-distribution hazards ratio models to determine the time to first event of ischemic, hemorrhagic or any stroke.

Results

After matching to examine exposure to incident AF, 35,024 matched pairs were identified. There were a total of 1781 (5.1%) strokes (85% ischemic) with an average time to stroke for patients with CKD + AF of 2.7 years (+/- 2.4) compared to 3.4 years (+/- 2.4) in patients with no AF. Among the entire cohort the presence of AF was associated with an increased risk of stroke with a HR of 2.93 (95%CI 2.67, 3.2). The crude rate of ischemic, hemorrhagic and any stroke were 16.24 (95%CI 15.43-17.08), 2.79 (95%CI 2.46-3.15) and 19.03 (95%CI 18.15-19.93) with AF and 4.38 (95%CI 4.01-4.78), 0.94 (95%CI 0.78-1.14) and 5.32 (95%CI 4.92-5.76) with no AF per 1000 person-years of follow up, respectively. Higher ACR and lower eGFR were associated with ischemic, hemorrhagic and any stroke compared to those with no AF, eGFR > 90 and ACR < 3 (p<0.0001 for all). The adjusted HR of stroke was higher across all categories of ACR and eGFR with the presence of AF compared to those without AF (ACR X stroke interaction p <0.0001, eGFR X stroke interaction p <0.0001).

Conclusion

CKD patients with atrial fibrillation are at a high risk of total, ischemic and hemorrhagic stroke and this risk is higher with lower eGFR and higher ACR.