Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca. Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV).
Thromb Haemost. 2018 Feb;118(2):279-287. doi: 10.1160/TH17-06-0416. Epub 2018 Jan 29.
One-third of atrial fibrillation (AF) patients have chronic kidney disease (CKD), a condition that itself increases thromboembolic and major bleeding risks, especially in patients with severe CKD. Bleeding would be accentuated by suboptimal anticoagulation control with vitamin K antagonists (VKA).
This article aimed to investigate the incidence of cardiovascular events, mortality and quality of anticoagulation in relation to CKD in a 'real-world' prospective cohort of AF patients included in the FANTASIIA registry.
We analysed consecutive AF patients who were prospectively recruited with a year of follow-up. The quality of anticoagulation was estimated by time in therapeutic range (TTR). The annual incidence of events was analysed.
We studied 1,936 patients (male: 55.7%, mean: 73.8 ± 9.4 years): 445 (22.9%) had normal function, 698 (36.1%) had mild CKD, 713 (36.8%) had moderate CKD and 80 (4.2%) had severe CKD. Patients with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m (severe CKD) had lower TTR (53.3 ± 25.6% vs. 61.8 ± 25.1%, = 0.007) and higher proportion of poor TTR (67.2 vs. 51.8%; = 0.014) than patients with eGFR ≥30 mL/min/1.73 m. Severe CKD was significantly associated with cardiovascular mortality (hazard ratio [HR]: 9.33; = 0.002), major bleeding (HR: 2.94; = 0.036) and major adverse cardiovascular events (MACE) (HR: 4.93; = 0.004). Importantly, 375 patients (21.1%) showed a deteriorating eGFR of ≥10 mL/min during the follow-up, with significantly higher mortality and cardiovascular events.
In a prospective and real-world AF registry, approximately 67% of patients with severe CKD had poor anticoagulation control while taking VKA. The presence of severe CKD was an independent factor for cardiovascular mortality, MACE and major bleeding. Worsening eGFR of only ≥10 mL/min during follow-up was significantly associated with mortality and major bleeding.
三分之一的心房颤动（AF）患者患有慢性肾脏病（CKD），这种疾病本身会增加血栓栓塞和大出血的风险，尤其是在患有严重 CKD 的患者中。维生素 K 拮抗剂（VKA）抗凝控制不理想会加重出血。
本文旨在研究 Fantasiaia 注册研究中前瞻性队列的 AF 患者中与 CKD 相关的心血管事件、死亡率和抗凝质量。
我们分析了连续的 AF 患者，这些患者前瞻性地接受了为期一年的随访。通过治疗范围时间（TTR）评估抗凝质量。分析了每年事件的发生率。
我们研究了 1936 名患者（男性：55.7%，平均年龄：73.8±9.4 岁）：445 名（22.9%）肾功能正常，698 名（36.1%）患有轻度 CKD，713 名（36.8%）患有中度 CKD，80 名（4.2%）患有严重 CKD。估计肾小球滤过率（eGFR）<30 mL/min/1.73 m （严重 CKD）的患者 TTR 较低（53.3±25.6%与 61.8±25.1%，=0.007），较差 TTR 的比例较高（67.2%与 51.8%；=0.014）比 eGFR≥30 mL/min/1.73 m 的患者。严重 CKD 与心血管死亡率（危险比[HR]：9.33；=0.002）、大出血（HR：2.94；=0.036）和主要不良心血管事件（MACE）（HR：4.93；=0.004）显著相关。重要的是，在随访期间，375 名患者（21.1%）的 eGFR 恶化≥10 mL/min，死亡率和心血管事件明显更高。
在一项前瞻性、真实世界的 AF 登记研究中，约 67%的严重 CKD 患者使用 VKA 时抗凝控制不佳。严重 CKD 的存在是心血管死亡率、MACE 和大出血的独立因素。仅在随访期间 eGFR 恶化≥10 mL/min 与死亡率和大出血显著相关。
