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Kidney function monitoring and trajectories in patients with atrial fibrillation

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Abstract

Background

Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently co-exist. The frequency of kidney monitoring and range of kidney function in patients with AF in clinical practice are uncertain.

Methods

All adult Albertans with AF between 2008 and 2017 were identified using ICD-9 and -10 codes 427.3 and I48. Kidney Disease Improving Global Outcomes (KDIGO) risk categories were defined using eGFR by the Chronic Kidney Disease Epidemiology Collaborative equation and albuminuria results within 6 months of eGFR measurement. eGFR trajectories were compared from baseline to maximum value within the following year.

Results

Among 105,946 patients with AF, 16.0% were KDIGO category G1 (eGFR ≥ 90), 49.0% G2 (60–89.9), 19.8% G3a (45–59.9), 11.4% G3b (30–44.9), and G4 3.8% (15–29.9). Albuminuria was normal/mild 83.4%, moderate 11.7%, and severe 4.9%. Kidney monitoring was more common among people with lower eGFR and worse albuminuria, from approximately twice annually for G1-2/A1-2 to 8 times annually in stage G4A3. Approximately 60–80% of patients received guideline-recommended monitoring, consistent across KDIGO stages. With lower baseline eGFR, annual change in eGFR decreased while the relative proportion of patients who worsened compared to improved increased: for baseline eGFR 60–89.9, 16.7% worsened vs 6.7% improved, but for eGFR 30–44.9, 8.8% worsened but only 1.0% improved.

Conclusion

The frequency of kidney function monitoring in patients with AF increased with worsening KDIGO risk category and adhered to KDIGO guidelines in approximately three quarters of patients. A minority of patients had moderate to severe eGFR impairment, of whom most remained stable over 1 year.

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Disclaimer

This study is based in part by data provided by Alberta Health and Alberta Health Services. The interpretation and conclusions contained herein are those of the researchers and do not represent the views of the Government of Alberta or Alberta Health Services. Neither the Government of Alberta nor Alberta Health or Alberta Health Services express any opinion in relation to this study.

Funding

This work was funded by the Heart and Stroke Foundation, Project Number: F16-03786. Dr. Hawkins receives salary support from Vancouver Coastal Health Research Institute (F17-05424), and is the UBC Dr. Charles Kerr Distinguished Scholar in Heart Rhythm Management. Dr. McAlister holds the University of Alberta Chair in Cardiovascular Outcomes Research. Dr. Kaul holds a CIHR Sex and Gender Science Chair and the Heart and Stroke Chair in Cardiovascular Research. None of these organizations were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication.

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Authors and Affiliations

  1. Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Room 9123, Vancouver, BC, V5Z 1M9, Canada

    Nathaniel M. Hawkins & Jason G. Andrade

  2. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Natasha Wiebe

  3. Smidt Heart Institute, Cedars-Sinai Medical Centre, Los Angeles, CA, USA

    Roopinder K. Sandhu

  4. Canadian Vigour Centre, University of Alberta, Edmonton, AB, Canada

    Roopinder K. Sandhu, Justin A. Ezekowitz & Padma Kaul

  5. Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada

    Justin A. Ezekowitz, Padma Kaul & Finlay A. McAlister

  6. University of Calgary, Calgary, AB, Canada

    Marcello Tonelli

  7. Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada

    Finlay A. McAlister

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  1. Nathaniel M. Hawkins
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Correspondence to Nathaniel M. Hawkins.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number Pro00053469) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hawkins, N.M., Wiebe, N., Andrade, J.G. et al. Kidney function monitoring and trajectories in patients with atrial fibrillation. Clin Exp Nephrol 27, 981–989 (2023). https://doi.org/10.1007/s10157-023-02389-z

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  • DOI: https://doi.org/10.1007/s10157-023-02389-z

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