Does advanced chronic kidney disease (stage 4 vs stage 3 or reference) increase prothrombotic and antifibrinolytic alterations in non-anticoagulated patients with atrial fibrillation?
Stage 4 CKD, but not stage 3 CKD, is associated with significant prothrombotic and antifibrinolytic alterations in non-anticoagulated AF patients, independent of clinical stroke risk factors.
It is unclear whether chronic kidney disease (CKD) increases thromboembolism in atrial fibrillation (AF). We conducted a retrospective cross-sectional analysis of 502 non-anticoagulated AF patients (median age, 66 (60-73) years, median CHA2DS2-VASc score, 3.0 (2.0-4.0)) with an estimated glomerular filtration rate (eGFR) ≥ 15 mL/min/1.73 m2. Endogenous thrombin potential (ETP), clot permeability (Ks), and clot lysis time (CLT), among others, were determined. Patients with stage 4 CKD (n = 87; 17.3%) had higher ETP and prolonged CLT compared with those with stage 3 CKD. In patients with stages 3 to 4 CKD (n = 180; 35.9%) N-terminal pro-B-type natriuretic peptide predicted low Ks (the lowest quartile, odds ratio OR per 100 pg/mL: 1.03, 95% confidence interval CI: 1.01-1.06) and prolonged CLT (the top quartile, OR per 100 pg/mL: 1.05, 95% CI: 1.02-1.08), but not high ETP. In the whole cohort, after adjustment for CHA2DS2-VASc score, stage 4 CKD, but not stage 3 CKD, predicted high ETP (OR: 9.06; 95% CI: 4.44-18.46) and prolonged CLT (OR: 3.58; 95% CI: 1.76-7.28), but not low Ks. compared to the reference eGFR category. This study is the first to demonstrate the prothrombotic and antifibrinolytic alterations in AF patients with stage 4 CKD, but not stage 3 CKD irrespective of clinical stroke risk factors.
Matusik et al. (Sat,) studied this question.
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