Key result
The combination of atrial fibrillation and chronic kidney disease was associated with a 4.2-fold increased risk of ischemic stroke compared to patients without either condition.
Why the study?
Both chronic kidney disease and atrial fibrillation are risk factors for bleeding, stroke, and mortality, but their interaction on these outcomes required investigation.
Does the combination of atrial fibrillation and chronic kidney disease synergistically increase the risk of bleeding, ischemic stroke, and mortality in patients with or at high risk for arterial disease?
Cohort (n=12,394)
No
Does the combination of atrial fibrillation and chronic kidney disease synergistically increase the risk of bleeding, ischemic stroke, and mortality in patients with or at high risk for arterial disease?
Hazard Ratio: 4.2 (95% CI 3–6)
Absolute Event Rate: 21.3% vs 2.9%
The combination of atrial fibrillation and chronic kidney disease synergistically increases the risk of ischemic stroke in patients with or at high risk for arterial disease.
Supports synergistic ischemic stroke risk with AF+CKD in arterial disease; hypothesis-generating, needs prospective confirmation before practice change.
BACKGROUND: Chronic kidney disease (CKD) and atrial fibrillation (AF) are both risk factors for bleeding, stroke and mortality. The aim of our study was to investigate the interaction between CKD and atrial fibrillation and outcomes. METHODS: We included 12,394 subjects referred to the University Medical Center Utrecht (the Netherlands) from September 1996 to February 2018 for an out-patient visit (Utrecht Cardiovascular Cohort Second Manifestation of Arterial disease cohort). Hazard ratios (HRs) with 95% confidence intervals (CIs) for bleeding, ischemic stroke or mortality were calculated with Cox proportional hazard analyses. Presence of interaction between AF and CKD was examined by calculating the relative excess risk due to interaction (RERI), the attributable proportion (AP) due to interaction and the synergy index (S). RESULTS: Of the 12,394 patients, 699 patients had AF, 2,752 patients had CKD and 325 patients had both AF and CKD. Patients with both CKD and AF had a 3.0-fold (95% CI 2.0-4.4) increased risk for bleeding, a 4.2-fold (95% CI 3.0-6.0) increased ischemic stroke risk and a 2.2-fold (95% CI 1.9-2.6) increased mortality risk after adjustment as compared with subjects without atrial fibrillation and CKD. We did not find interaction between AF and CKD for bleeding and mortality. However, we found interaction between AF and CKD for ischemic stroke risk (RERI 1.88 (95% CI 0.31-3.46), AP 0.45 (95% CI 0.17-0.72) and S 2.40 (95% CI 1.08-5.32)). CONCLUSION: AF and CKD are both associated with bleeding, ischemic stroke and mortality. There is a positive interaction between AF and CKD for ischemic stroke risk, but not for bleeding or mortality.
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Ocak et al. (2022) conducted a cohort in High cardiovascular risk or clinical manifest arterial disease (n=12,394). Combination of atrial fibrillation and chronic kidney disease vs. Absence of both atrial fibrillation and chronic kidney disease was evaluated on Ischemic stroke (HR 4.2, 95% CI 3.0-6.0). The combination of atrial fibrillation and chronic kidney disease was associated with a 4.2-fold increased risk of ischemic stroke compared to patients without either condition.
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