AFib Raises Stroke Risk in Patients With CKD
Individuals with chronic kidney disease (CKD) with atrial fibrillation (AF) have an increased risk for total, ischemic, and hemorrhagic stroke, according to a recent study.
Findings were presented at the American Society of Nephrology’s Kidney Week 2017, which is taking place from October 31 to November 5, 2017, in New Orleans, Louisiana.
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It is well known that CKD and AF are associated with a higher risk for ischemic and hemorrhagic stroke. However, the impact of albuminuria and estimated glomerular filtration rate (eGFR) on this risk is not yet known.
For their study, the researchers assessed 736,666 patients from 2002 to 2015 in Ontario, Canada. Of these, 35,024 had developed incident AF and had albumin-to-creatinine ratio (ACR) and eGFR measurements that had been taken within 12 months of developing AF.
Hospital diagnostic codes at admission were used to evaluate AF and stroke. The time to first event of ischemic, hemorrhagic, or any stroke were determined via propensity-score matched Cox proportional and Fine and Grey sub-distribution hazards ratio (HR) models.
A total of 35,024 matched pairs were identified after matching examine exposure to incident AF. Results indicated that 1781 (5.1%) strokes had occurred, of which 85% were ischemic strokes. Average time to stroke was 2.7 years in patients with CKD with AF, compared with 3.4 years in patients without AF.
The presence of AF was associated with a higher risk of stroke in all patients in the study (HR 2.93). Crude rates in patients with AF were 16.24 for ischemic stroke, 2.79 for hemorrhagic stroke, and 19.03 for any stroke, compared with 4.38 for ischemic stroke, 0.94 for hemorrhagic stroke, and 5.32 for any stroke among patients with no AF per 1000 person-years of follow up.
Additionally, higher ACR and lower eGFR were associated with the risk for ischemic, hemorrhagic, and any stroke, compared with patients without AF, with eGFR or less than 90 mL/min/1.73m2, and with ACR of less than 3 mg/g. The adjusted HR of stroke had been higher in all categories of ACR and eGFR in patients with AF vs those without AF.
“CKD patients with atrial fibrillation are at a high risk of total, ischemic, and hemorrhagic stroke, and this risk is higher with lower eGFR and higher ACR,” the researchers concluded.
—Christina Vogt
Reference:
Sood MM, Lam N, Mccallum MK, Garg AX, Molnar AO. The risk of stroke with atrial fibrillation in CKD patients. Paper presented at: American Society of Nephrology Kidney Week 2017; October 31-November 5, 2017; New Orleans, LA. https://www.asn-online.org/education/kidneyweek/2017/program-abstract.aspx?controlId=2789156.