The CHADS-VASc score strongly correlates with glomerular filtration rate and predicts renal function decline over time in elderly patients with atrial fibrillation and chronic kidney disease.

BACKGROUND

The decline of renal function affects stroke risk in patients with atrial fibrillation (AF). Here, we aim to study the predictive value of the CHADS-VASc score, a stroke-risk stratification model in AF, for renal function and renal decline in patients with AF and chronic kidney disease (CKD).

METHODS

Two electronic health record cohorts with AF and CKD stage III/IV were evaluated (Cohort #1 (IMS-DA, Germany): 18,539 patients with 125,149 estimated glomerular filtration rate (eGFR) measurements; Cohort #2 (IMS-THIN, United Kingdom): 18,240 patients with 133,676 eGFR measurements). The eGFR trajectories were analysed with multi-level mixed-effects regression and joint models for longitudinal and survival data.

RESULTS

In IMS-DA, the mean baseline eGFR was 52.0ml/min/1.73m, and declined by 1.03ml/min/1.73m/year (95%CI: 0.86-1.19, p<0.0001). In IMS-THIN, the mean baseline eGFR was 48.0ml/min/1.73m, and declined by 0.44ml/min/1.73m/year (95%CI: 0.37-0.51, p<0.0001). In both datasets, higher CHADS-VASc scores (median: 4 points) were strongly associated with both lower baseline eGFR (p<0.0001) and faster progression of CKD (p=0.002). Mean baseline eGFR values were higher in patients with a CHADS-VASc score of 0 compared to patients with a score of 8 points. Conversely, the annual declines in eGFR were lower in patients with a score of 0 compared to patients with a score of 8 points in both databases.

CONCLUSION

The CHADS-VASc score can identify AF patient subgroups with lower baseline eGFR and a higher risk of CKD progression, which has important implications for the management of anticoagulation in these patients.