Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2015; 7(10): 685-694
Published online Oct 26, 2015. doi: 10.4330/wjc.v7.i10.685
Renal function assessment in atrial fibrillation: Usefulness of chronic kidney disease epidemiology collaboration vs re-expressed 4 variable modification of diet in renal disease
Rami Riziq-Yousef Abumuaileq, Emad Abu-Assi, Andrea López-López, Sergio Raposeiras-Roubin, Moisés Rodríguez-Mañero, Luis Martínez-Sande, Francisco Javier García-Seara, Xesus Alberte Fernandez-López, Jose Ramón González-Juanatey
Rami Riziq-Yousef Abumuaileq, Emad Abu-Assi, Andrea López-López, Sergio Raposeiras-Roubin, Moisés Rodríguez-Mañero, Luis Martínez-Sande, Francisco Javier García-Seara, Xesus Alberte Fernandez-López, Jose Ramón González-Juanatey, Cardiology Department, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The study was reviewed and approved by our Institutional Review Board.
Informed consent statement: This retrospective cohort study does not have any risk to the enrolled patients, and was approved by the Research Ethics Committee of our institution according to the Helsinki declaration.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at drrami2012@hotmail.com
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rami Riziq-Yousef Abumuaileq, MD, Cardiology Department, University Clinical Hospital of Santiago de Compostela, A choupana s/n, 15706 Santiago de Compostela, Spain. drrami2012@hotmail.com
Telephone: +34-981-950778 Fax: +34-981-950534
Received: June 15, 2015
Peer-review started: June 16 2015
First decision: July 3, 2015
Revised: July 17, 2015
Accepted: September 16, 2015
Article in press: September 16, 2015
Published online: October 26, 2015
Abstract

AIM: To compare the performance of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation.

METHODS: We studied 911 consecutive patients with non-valvular atrial fibrillation on vitamin-K antagonist. The performance of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation with respect to either a composite endpoint of major bleeding, thromboembolic events and all-cause mortality or each individual component of the composite endpoint was assessed using continuous and categorical ≥ 60, 59-30, and < 30 mL/min per 1.73 m2 estimated glomerular filtration rate.

RESULTS: During 10 ± 3 mo, the composite endpoint occurred in 98 (10.8%) patients: 30 patients developed major bleeding, 18 had thromboembolic events, and 60 died. The new equation provided lower prevalence of renal dysfunction < 60 mL/min per 1.73 m2 (32.9%), compared with the re-expressed equation (34.1%). Estimated glomerular filtration rate from both equations was independent predictor of composite endpoint (HR = 0.98 and 0.97 for the re-expressed and the new equation, respectively; P < 0.0001) and all-cause mortality (HR = 0.98 for both equations, P < 0.01). Strong association with thromboembolic events was observed only when estimated glomerular filtration rate was < 30 mL/min per 1.73 m2: HR is 5.1 for the re-expressed equation, and HR = 5.0 for the new equation. No significant association with major bleeding was observed for both equations.

CONCLUSION: The new equation reduced the prevalence of renal dysfunction. Both equations performed similarly in predicting major adverse outcomes.

Keywords: Atrial fibrillation, Anticoagulants, Follow-up studies, Kidney, Prognosis

Core tip: In atrial fibrillation, renal dysfunction entails more adverse events. Limited data exist on the performance and prognostic value of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in atrial fibrillation. We compared the performance of both equations at predicting major outcomes in patients with non-valvular atrial fibrillation. The study encouraged the use of the new equation as it decreased the prevalence of patients with renal dysfunction, in a real world cohort of patients with non-valvular atrial fibrillation and at the same time showed similar prognostic impact like the re-expressed equation.