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Original Research: Cardiovascular Disease |

A Prospective Study of Estimated Glomerular Filtration Rate and Outcomes in Patients With Atrial FibrillationRenal Function and Outcomes in Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project

Amitava Banerjee, MPH, DPhil; Laurent Fauchier, MD, PhD; Patrick Vourc’h, PhD; Christian R. Andres, MD, PhD; Sophie Taillandier, MD; Jean Michel Halimi, MD, PhD; Gregory Y. H. Lip, MD
Author and Funding Information

From the University of Birmingham Centre for Cardiovascular Sciences (Drs Banerjee and Lip), City Hospital, Birmingham, England; Service de Cardiologie, Pôle Coeur Thorax Vasculaire (Drs Fauchier and Taillandier), Centre Hospitalier, Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France; Laboratoire de Biochimie et Biologie moléculaire (Drs Vourc’h and Andres), Hôpital Bretonneau, Centre Hospitalier régional et Universitaire de Tours, Tours, France; and Service de Nephrologie-Immunologie Clinique (Dr Halimi), Hôpital Bretonneau and Université François Rabelais, Tours, France.

Correspondence to: Gregory Y. H. Lip, MD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Rd, Birmingham, B18 7QH, England; e-mail: g.y.h.lip@bham.ac.uk


Drs Halimi and Lip are joint senior authors.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1370-1382. doi:10.1378/chest.13-2103
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Background:  Atrial fibrillation (AF) is more likely to develop in patients with chronic kidney disease (CKD) than in individuals with normal renal function, and patients with CKD are more likely to suffer ischemic stroke (IS)/thromboembolism (TE). To our knowledge, no prior study has considered the impact of estimated glomerular filtration rate (eGFR) on bleeding. We investigated the relationship of eGFR to IS/TE, mortality, and bleeding in an AF population unrestricted by age or comorbidity.

Methods:  Patients with nonvalvular AF (NVAF) were stratified into five categories according to eGFR (≥ 90, 60-89, 30-59, 15-29, and < 15 mL/min/1.73 m2), analyzing risk factors, all-cause mortality, bleeding, and IS/TE. Of 8,962 eligible individuals, 5,912 had NVAF and available serum creatinine data, with 14,499 patient-years of follow-up.

Results:  The incidence rates of IS/TE were 7.4 and 7.2 per 1,000 person-years in individuals not receiving and receiving anticoagulation therapy, respectively. Rates of all-cause mortality were 13.4 and 9.4 per 1,000 person-years, respectively, and of major bleeding, 6.2 and 9.0 per 1,000 person-years, respectively. Rates increased with decreasing eGFR, with IS/TE rates being lower in individuals receiving oral anticoagulation (OAC) therapy. eGFR was not an independent predictor of IS/TE on multivariate analyses. When the benefit of IS reduction is balanced against the increased risk of hemorrhagic stroke, the net clinical benefit (NCB) was clearly positive in favor of OAC use.

Conclusions:  Incidence rates of IS/TE, mortality, and bleeding increased with reducing eGFR across the whole range of renal function. OAC use was associated with a lower incidence of IS/TE and mortality at 1 year compared with individuals not receiving anticoagulants in all categories of renal function as measured by eGFR. The NCB balancing IS against serious bleeding was positive in favor of OAC use among patients with renal impairment.

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