Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China.
Division of Nephrology, The First Affiliated Hospital of Nanjing Medical University , Nanjing, China.
Postgrad Med. 2020 Jun;132(5):452-457. doi: 10.1080/00325481.2020.1739914. Epub 2020 Mar 14.
Renal impairment and atrial fibrillation (AF) often coexist. However, risk factors associated with renal impairment in AF patients have not been studied in a large population. Accordingly, this study investigated clinical factors associated with renal impairment in AF patients.
From January 2012 to December 2016, 2,298 inpatients with non-valvular AF (NVAF) mainly for catheter ablation were enrolled in this cross-sectional study. Data collection included past medical history, echocardiography measurements, current medicine use and biochemical results. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Renal impairment was defined as a history of chronic kidney disease or an eGFR ≤90 ml/min/1.73 m. Multivariate logistic regression was conducted to evaluate the relationship between the factors screened and eGFR.
The mean eGFR was 88.6 ± 17.1 ml/min/1.73 m. The overall prevalence of renal impairment was 47.4%. Multivariate logistic regression showed that factors associated with renal impairment were age (OR: 1.12; 95% CI: 1.11-1.14), non-paroxysmal AF (OR: 1.28; 95% CI: 1.04-1.58), use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (OR: 1.58; 95% CI: 1.28-1.95), congestive heart failure (OR: 1.80; 95% CI: 1.05-3.07), left ventricular ejection fraction (LVEF) <50% (OR: 2.39; 95% CI: 1.34-4.28), and prior transient ischemic attack (TIA)/stroke/systematic embolism (SE) (OR: 2.69; 95% CI: 1.68-4.29).
Renal dysfunction is highly prevalent in Chinese NVAF patients and is significantly associated with older age, non-paroxysmal AF, use of ACEI/ARB, congestive heart failure, LVEF <50% and prior TIA/stroke/SE. Further studies on the mechanisms by which these risk factors affect renal function in NVAF patients need to be conducted.
肾功能损害和心房颤动（AF）常并存。然而，在大型人群中，与 AF 患者肾功能损害相关的危险因素尚未得到研究。因此，本研究调查了 AF 患者肾功能损害的相关临床因素。
本横断面研究纳入了 2012 年 1 月至 2016 年 12 月间 2298 例非瓣膜性心房颤动（NVAF）住院患者（主要为导管消融治疗）。数据收集包括既往病史、超声心动图测量、当前用药和生化结果。使用简化慢性肾脏病流行病学合作研究（CKD-EPI）方程计算估算肾小球滤过率（eGFR）。将慢性肾脏病病史或 eGFR≤90ml/min/1.73m 定义为肾功能损害。采用多变量逻辑回归评估筛选出的因素与 eGFR 之间的关系。
平均 eGFR 为 88.6±17.1ml/min/1.73m。肾功能损害的总患病率为 47.4%。多变量逻辑回归显示，与肾功能损害相关的因素包括年龄（OR：1.12；95%CI：1.11-1.14）、非阵发性 AF（OR：1.28；95%CI：1.04-1.58）、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）的使用（OR：1.58；95%CI：1.28-1.95）、充血性心力衰竭（OR：1.80；95%CI：1.05-3.07）、左心室射血分数（LVEF）<50%（OR：2.39；95%CI：1.34-4.28）和既往短暂性脑缺血发作（TIA）/中风/系统性栓塞（SE）（OR：2.69；95%CI：1.68-4.29）。
中国 NVAF 患者肾功能障碍发生率较高，与年龄较大、非阵发性 AF、ACEI/ARB 的使用、充血性心力衰竭、LVEF<50%和既往 TIA/中风/SE 显著相关。需要进一步研究这些危险因素影响 NVAF 患者肾功能的机制。
