A prospective study of estimated glomerular filtration rate and outcomes in patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project

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A prospective study of estimated glomerular filtration rate and outcomes in patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project
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    Online First articles are not copyedited prior to posting.  ©American College of Chest Physicians. Reproduction of this article is prohibited without written permission from the  American College of Chest Physicians. See online for more details. ONLINE FIRST   This is an Online First, unedited version of this article. The final, edited version will appear in a numbered issue of CHEST   and may contain substantive changes. We encourage readers to check back for the final article. Online First papers are indexed in PubMed and by search engines, but the information, including the final title and author list, may be updated on final publication. http://journal.publications.chestnet.org/   Page 1 of 37 Downloaded From: http://journal.publications.chestnet.org/ by a University of Birmingham User on 01/14/2014  1 A prospective study of estimated glomerular filtration rate and outcomes in patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project   Amitava Banerjee MPH DPhil 1  a.banerjee.1@bham.ac.uk Laurent Fauchier MD PhD 4  lfau@med.univtur!.fr Patrick "urc#h PhD $  vurch@med.univtur!.fr %hri!tian &. Andre! MD' PhD $ andre!@med.univtur!.fr    ()hie *aillandier MD 4 !fi.taillandier@+ah.fr ,ean Michel Halimi- MD PhD  halimi@med.univtur!.fr. /re0r+ . H. Li)- MD 1  0.+.h.li)@bham.ac.uk 2-jint !enir authr!3 1  niver!it+ f Birmin0ham %entre fr %ardiva!cular (cience!' %it+ H!)ital' Birmin0ham B15 67H' 89  (ervice de :e)hrl0ie;mmunl0ie %lini<ue' H=)ital Bretnneau and niver!it> Fran?i! &abelai!' *ur!' France9 $ Labratire de Bichimie et Bil0ie ml>culaire' H)ital Bretnneau' %entre H!)italier r>0inal et niver!itaire de *ur!9  4 (ervice de %ardil0ie' Ple %eur *hra "a!culaire' %entre H!)italier' niver!itaire *ru!!eau et Facult> de M>decine' niver!it> Fran?i! &abelai!' *ur!' France Corresponding author Prf /H Li) 0.+.h.li)@bham.ac.ukC' niver!it+ f Birmin0ham %entre fr %ardiva!cular (cience!' %it+ H!)ital' Birmin0ham B15 67H' 8  Running title: !timated 0lmerular filtratin rate in )atient! Eith AF Page 2 of 37   Downloaded From: http://journal.publications.chestnet.org/ by a University of Birmingham User on 01/14/2014  2 Abstract    Background: Patient! Eith chrnic kidne+ di!ea!e %8DC are mre likel+ t devel) atrial fibrillatinAFC than individual! Eith nrmal renal functin' and are mre likel+ t !uffer i!chaemic !trke;(Cthrmbembli!m*C. : )rir !tud+ ha! cn!idered the im)act f e/F& n bleedin0. Ge inve!ti0ated the relatin!hi) f e/F& t ;(*' mrtalit+ and bleedin0 in an AF ))ulatin' unre!tricted b+ a0e r cmrbidit+.  Methods: Patient! Eith nnvalvular AF :"AFC Eere !tratified int five cate0rie! accrdin0 t e/F&mlmin1.6$ m  C IJK'K5J'$KJ'1J and N1' anal+!in0 ri!k factr!' allcau!e mrtalit+'  bleedin0 and ;(*. Of 5J eli0ible individual!' J1 had :"AF and available !erum creatinine data' Eith 144JJ )atient+ear! f fllEu).  Results  ;n nnantica0ulated and antica0ulated individual!' the incidence rate! f ;(* Eere 6.4 and 6. )er 1KKK )er!n+ear!' re!)ectivel+. &ate! f allcau!e mrtalit+ Eere 1$.4 and J.4 )er 1KKK )er!n+ear!' re!)ectivel+' and f majr bleedin0' . and J.K )er 1KKK )er!n+ear!' re!)ectivel+. &ate! increa!ed Eith decrea!in0 e/F& Eith ;(* rate! bein0 lEer in individual! receivin0 OA%. e/F& Ea! nt an inde)endent )redictr f ;(* n multivariate anal+!e!. Ghen the benefit f ;( reductin i! balanced a0ain!t the increa!ed ri!k f haemrrha0ic !trke' the net clinical benefit :%BC Ea! clearl+ )!itive in favur f OA% u!e. Conclusion: ;ncidence rate! f ;(*' mrtalit+ and bleedin0 increa!ed Eith reducin0 e/F&'   acr!! the Ehle ran0e f renal functin. OA% u!e Ea! a!!ciated Eith a lEer incidence f ;(* and mrtalit+ at 1 +ear' cm)ared Eith nnantica0ulated individual! in all cate0rie! f renal functin a! mea!ured b+ e/F&. *he :%B balancin0 ;( a0ain!t !eriu! bleedin0 Ea! )!itive' in favur f OA% u!e amn0!t )atient! Eith renal im)airment.   Key words:  e!timated 0lmerular filtratin rate' atrial fibrillatin' !trke' bleedin0' renal im)airment' !urvival Page 3 of 37 Downloaded From: http://journal.publications.chestnet.org/ by a University of Birmingham User on 01/14/2014  3 Abbreviations and Acronyms  :"AF :nvalvular atrial fibrillatin * *hrmbembli!m ;( ;!chaemic !trke %HAD(   Acrn+m fr %n0e!tive heart failure' H+)erten!in' A0e I6 +ear!' Diabete!' )reviu! (trke %HA  D(  "A(c Acrn+m fr %n0e!tive heart failure' H+)erten!in' A0e I6 +ear!' Diabete!' )reviu! (trke' "a!cular di!ea!e' A0e 64 +ear!' (e cate0r+ femaleC HA(BLD H+)erten!in' Abnrmal renalliver functin' (trke' Bleedin0 hi!tr+ r )redi!)!itin' Labile internatinal nrmalied rati' lderl+ Q    +ear!C' Dru0!alchl cncmitantl+ "8A "itamin 8 anta0ni!t OA% Oral antica0ulatin e/F& !timated 0lmerular filtratin rate Page 4 of 37 Downloaded From: http://journal.publications.chestnet.org/ by a University of Birmingham User on 01/14/2014  4 ntroduction ;m)airment f renal functin and atrial fibrillatin AFC are bth inde)endentl+ a!!ciated Eith  )r cardiva!cular utcme! and allcau!e mrtalit+' )re!entin0 a 0rEin0 0lbal burden f di!ea!e 11 . Mrever' AF and chrnic kidne+ di!ea!e %8DC !hare !everal ri!k factr!' includin0 a0e' h+)erten!in' hi!tr+ f va!cular di!ea!e and diabete! mellitu!. *hu!' im)rved under!tandin0 f the a!!ciatin! betEeen renal functin and AF ma+ lead t neE a))rache! in ri!k !tratificatin' mana0ement and )reventin. ;ndividual! Eith %8D are mre likel+ t devel) AF 1$14 ' i!chaemic !trke;(C and thrmbembli!m*C 1  than )atient! Eith nrmal renal functin. ;n a lar0e )r!)ective !tud+ f 1$'$6 Dani!h individual! Eith AF' Ehere $56 individual! had %8D' the latter Ea! a!!ciated Eith increa!ed ri!k f ;(* and bleedin0 1 ' thu! cnfirmin0 b!ervatin! f )reviu! !maller !tudie! 161 . HEever' the !tud+ b+ Ole!en et al 1  Ea! a natinEide re0i!tr+ chrt' Ehich nl+ cate0ri!ed )atient! a! Rn renal di!ea!eS' Rnnend !ta0e %8DS and Rrenal re)lacement thera)+S.   ;n clinical )ractice' renal functin i! <uantified b+ urinar+ creatinine clearance r b+ the e!timated 0lmerular filtratin rate e/F&C 4 . Onl+ tE )reviu! !tudie! have cn!idered the a!!ciatin  betEeen e/F& and !trke* 1'  ' includin0 nl+ time ff ral antica0ulatin OA%C. : e)idemil0ic !tudie! have cn!idered the im)act f e/F& n majr bleedin0 and all longterm  utcme! cncurrentl+' nr included individual! Eith AF re0ardle!! f OA% u!e 4' 1'  . *herefre the balance betEeen ri!k f ;(* and bleedin0 ha! nt been <uantified b+ e/F& in a lar0e Treal ErldU ))ulatin f individual! Eith AF. Of nte' renal failure i! included a! a dichtmu! variable in ri!k )redictin tl! fr bleedin0 but i! rarel+ included in 0uidelinerecmmended ri!k )redictin tl! fr ;(* 1' ' 6$K ' Ehich i! !u))rted b+ a recent anal+!i! in ur chrt Ehich )rved that renal im)airment and e/F& d nt im)rve ri!k )redictin f ;(* $1 . HEever' thi! anal+!i! al! !hEed that renal im)airment Ea! a!!ciated Eith hi0her rate! f ;(*' cm)ared t nrmal renal functin. Better under!tandin0 f the im)act f renal functin and e/F& n clinical utcme! in AF i! re<uired. ;n a ))ulatin f individual! Eith AF' unre!tricted b+ a0e r cmrbidit+' Ee cnducted the fir!t  )r!)ective !tud+ f renal functin' a! mea!ured b+ e/F&' n ;(*' mrtalit+ and bleedin0. Page 5 of 37 Downloaded From: http://journal.publications.chestnet.org/ by a University of Birmingham User on 01/14/2014
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