31 Dec Atrial Fibrillation: Impact of Kidney Function
MedicalResearch.com: What are the main findings of the study?
This was the first long-term study in individuals with atrial fibrillation to consider the impact of renal function, as measured by eGFR, on stroke/thromboembolism, mortality and bleeding in the same population concurrently.
Answer: There were three main findings of our study.
- First, patients with worsening renal function had more severe risk factor profiles and had higher rates of stroke/thromboembolism, mortality and bleeding.
- Second, individuals receiving oral anticoagulation had lower rates of stroke/thromboembolism and mortality than those not receiving anticoagulation at all levels of renal function measured by eGFR, suggesting that anticoagulation has benefit in even patients with low eGFR.
- Third, renal function was not an independent predictor of stroke/thromboembolism at 1 year after adjustment for baseline characteristics.
MedicalResearch.com: Were any of the findings unexpected?
Answer: Given the fact that patients with poor renal function had increased rates of stroke/thromboembolism, it was surprising that renal function, as measured by eGFR was not independently associated with stroke/thromboembolism after adjustment for other risk factors. Our findings suggest that the risk associated with poor renal function, is already captured by other risk factors such as age, diabetes mellitus, hypertension and heart failure.
MedicalResearch.com: What should clinicians and patients take away from your report?
Answer: Although renal function was not an independent predictor of stroke/thromboembolism in individuals with atrial fibrillation, these patients are still at high risk, and regular checking of renal function (as measured by eGFR) would be recommended, especially because normal or mild renal impairment at baseline does not preclude some patients from deteriorating to severe renal impairment. Full anticoagulation is recommended in patients with at least moderate renal impairment.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Answer: Net clinical benefit weighs up the risk of stroke/thromboembolism versus the risk of bleeding. Our data suggested that oral anticoagulation may have the greatest net clinical benefit in individuals with atrial fibrillation and renal failure. However, our data are observational data and not clinical trial data. Trials of oral anticoagulation are urgently required in patients with renal impairment to determine the balance between efficacy and safety of anticoagulation in this patient group. This is especially important because the majority of trials in patients with atrial fibrillation have excluded patients with renal impairment.