Impact of estimated glomerular filtration rate on long-term clinical outcomes among Chinese patients with atrial fibrill
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RESEARCH ARTICLE
Impact of estimated glomerular filtration rate on long‑term clinical outcomes among Chinese patients with atrial fibrillation Huaibin Wan1* , Juan Wang2, Yanmin Yang2, Xin Fan1, Dongdong Chen3 and Ning Bian3
Abstract Background: Estimated glomerular filtration rate (eGFR) is a widely accepted indicator of renal function. The aim of this study was to evaluate the relationship between eGFR and 3-year clinical outcomes among Chinese patients with atrial fibrillation (AF). Methods: We retrospectively studied 433 consecutive Chinese patients with AF (51.0% males, mean age 65.6 ± 13.2 years) between February 2013 and December 2017. Baseline clinical data were collected according to medical records. eGFR was calculated by MDRD equation for Chinese patients according to baseline age, sex and serum creatinine. The primary clinical outcome of interest was all-cause mortality. Results: During a median follow-up period of 3.1 (0.5–4.5) years, 73 deaths (16.9%) were recorded. Multivariate Cox regression analyses indicated that eGFR was independently associated with all-cause death in total population [hazard ratio (HR) 0.984; 95% confidence interval (CI) 0.972–0.995, P = 0.006] and patients free of valvular heart diseases (VHDs) (HR 0.975; 95% CI 0.959–0.992, P = 0.003), but not with VHDs. A receiver operating characteristic (ROC) analysis revealed that reduced eGFR predicted all-cause mortality with areas under the ROC curve of 0.637 (95% CI 0.539– 0.735, P = 0.004) in AF patients free of VHDs. Conclusions: eGFR is an independent predictor of 3-year all-cause mortality among Chinese patients with AF, especially among those patients free of VHDs. Keywords: Estimated glomerular filtration rate, Atrial fibrillation, Survival Background Atrial fibrillation (AF) is the most common sustained arrhythmia with increased risks of stroke and systemic embolism, accounting for about one third of all hospitalized adults with arrhythmias [1, 2]. The prevalence of AF is increasing with age and various cardiovascular risk factors [1, 2]. Glomerular filtration rate (GFR), which can be estimated from age, sex and serum creatinine (estimated GFR, eGFR), is a widely accepted indicator of *Correspondence: [email protected] 1 Department of Cardiology, Dongguan People’s Hospital, Southern Medical University, Guangdong, China Full list of author information is available at the end of the article
renal function [3]. It has been identified that eGFR was independently as well as jointly with other indicators providing statistically significant improvement in predicting cardiovascular events [4–6]. Previous studies have shown that renal impairment and reduced eGFR were risk factors for developing AF [7, 8]. In patients after AF catheter ablation, there was an inverse association between eGFR levels and AF recurrences [9]. And eliminating AF by catheter ablation was beneficial to renal function improving over a 5-year follow-up study [10]. AF and chronic kidney disease (CKD) frequently coexist [11]. Therefore, concu
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