Impact of moderate to severe renal impairment on long-term clinical outcomes in patients with atrial fibrillation

Background: The deleterious effect of renal impairment in non-valvular atrial fibrillation (AF) patients has recently been reported. We investigated the impact of moderate to severe renal impairment on long-term clinical outcomes in AF patients. Methods: A total of 2126 AF patients were enrolled and divided into two groups according to >= or <60 mL/min estimated glomerular filtration rate (eGFR). Clinical outcomes including all-cause death, cardiac death, ischemic stroke (IS), bleeding, and admission for heart failure (HF) were analyzed. Results: Compared to the >= 60 mL/min eGFR group, <60 mL/min eGFR patients were older; had a higher proportion of females; were more likely to have diabetes, hypertension, and history of stroke; and had higher CHADS(2), CHA(2)DS(2)-VAS(c), and HAS-BLED scores. During the follow-up period (median 6.23 years), all-cause death, bleeding, admission for HF, and progression to persistent or permanent AF were significantly increased in the <60 mL/min eGFR group compared to the >= 60 mL/min eGFR group. After multivariate Cox regression analyses, <60 mL/min eGFR increased the risk of all-cause death [hazard ratio (HR): 1.84; 95% confidence interval (CI): 1.03-3.28, p = 0.04] and bleeding (HR: 1.28; 95% CI: 1.04-1.57, p = 0.02). IS was only significantly increased in the <60 mL/min eGFR group not receiving antithrombotic treatment. Conclusion: Moderate to severe renal impairment is a poor prognostic factor of long-term clinical outcomes in AF patients. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.