April 22, 2016Open Access
Chronic Kidney Disease, Time in Therapeutic Range and Adverse Clinical Outcomes in Anticoagulated Patients with Non-valvular Atrial Fibrillation: Observations from the SPORTIF Trials
Key Result
Chronic kidney disease in atrial fibrillation patients independently predicted stroke (p=0.006) and death (p<0.001), while TTR >70% predicted lower risks of stroke, death, and major bleeding.
Study Design
Type
Observational (n=3,646)
Multicenter
Yes
Structured PICO
Does chronic kidney disease and time in therapeutic range impact the risk of stroke, death, and major bleeding in anticoagulated patients with non-valvular atrial fibrillation?
P
Population
3646 patients with non-valvular atrial fibrillation assigned to warfarin with data on renal function from the SPORTIF III and V trials
I
Intervention
Chronic kidney disease (creatinine clearance <60ml/min) and time in therapeutic range (TTR) >70%
C
Comparator
Normal renal function and TTR <70%
O
Outcome
Stroke and deathhard clinical
In AF patients on warfarin, CKD is highly prevalent and predicts stroke and death, while maintaining a TTR >70% independently reduces the risk of stroke, death, and major bleeding.
Main Result
p-value: p=0.006 for stroke, <0.001 for death
Abstract
BACKGROUND: Chronic kidney disease (CKD) is highly prevalent in atrial fibrillation (AF) patients and associated with an increased risk of adverse outcomes. Our objectives were to study clinical features associated with CKD in AF patients and the impact of CKD on anticoagulation control, as reflected by time in therapeutic range (TTR). We also determined the impact of CKD and TTR in predicting adverse outcomes. METHODS AND RESULTS: We analysed pooled datasets from SPORTIF III and V trials, including 3646 patients assigned to warfarin with data on renal function. CKD (creatinine clearance 70%, whilst diabetes mellitus, aspirin use and CKD were inversely associated with TTR>70%. On Cox regression analysis, CKD was an independent predictor for stroke (p=0.006) and death (p70% was independently associated with a lower risk of stroke (p=0.024), death (p=0.001) and major bleeding (p=0.001). CONCLUSIONS: CKD is highly prevalent amongst AF patients and a risk factor for stroke and death. Adjusting for CKD, good quality anticoagulation control (TTR>70%) was an independent predictor for lower risks of stroke, death and major bleeding.