Which kidney function estimate should guide anticoagulant dosing and risk assessment in atrial fibrillation?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Atrial fibrillation (n=3804). Intervention: eGFRdiff below -10 mL/min/1.73 m2 vs. eGFRdiff -10 to 10 mL/min/1.73 m2. Primary outcome: Major adverse cardiovascular events (MACE) (HR 1.50).

Chih‐Min Liu; Tze‐Fan Chao

doi:10.1093/ehjopen/oeag146

September 1, 2026European Heart Journal OpenOpen Access

Which kidney function estimate should guide anticoagulant dosing and risk assessment in atrial fibrillation?

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Why the study?

Does the difference between cystatin C-based and creatinine-based eGFR (eGFRdiff) predict adverse outcomes in patients with atrial fibrillation?

Structured PICO

Does the difference between cystatin C-based and creatinine-based eGFR (eGFRdiff) predict adverse outcomes in patients with atrial fibrillation?

P

Population

3,804 patients with atrial fibrillation from the prospective Swiss-AF and Beat-AF cohorts evaluated for discordance between creatinine and cystatin C-based kidney function estimates.

E

Exposure

Measurement of eGFRdiff (cystatin C-based eGFR minus creatinine-based eGFR) as a prognostic marker

C

Comparator

eGFRdiff of -10 to 10 mL/min/1.73 m2

O

Outcome

Major adverse cardiovascular events (MACE) and heart failure (HF) hospitalizationcomposite

Main Result

Hazard Ratio: 1.5

Limitations

Observational design cannot exclude reverse causation, whereby advanced disease drives both biomarkers and discordance.
Brain imaging was limited to the older, more comorbid Swiss-AF cohort, raising selection bias.
Observational design cannot exclude reverse causation
Brain imaging was limited to the older, more comorbid Swiss-AF cohort, raising selection bias

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Implication

Discordance between cystatin C- and creatinine-based eGFR identifies a high-risk phenotype in AF patients, though DOAC dosing should remain guided by the Cockcroft-Gault equation as validated in pivotal trials.

Abstract

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Cite This Study

Liu et al. (2026) conducted an editorial in Atrial fibrillation (n=3,804). eGFRdiff below -10 mL/min/1.73 m2 vs. eGFRdiff -10 to 10 mL/min/1.73 m2 was evaluated on Major adverse cardiovascular events (MACE) (HR 1.50).

synapsesocial.com/papers/6ad1158c00741cc3fba7d59e https://doi.org/10.1093/ehjopen/oeag146

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Which kidney function estimate should guide anticoagulant dosing and risk assessment in atrial fibrillation?

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Which kidney function estimate should guide anticoagulant dosing and risk assessment in atrial fibrillation?

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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