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The CHA2DS2-VASc score predicts chronic kidney disease among patients with atrial fibrillation

  • Nephrology - Original Paper
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Abstract

Background

It is unclear how the CHA2DS2-VASc score can predict subsequent chronic kidney disease (CKD) and end-stage renal disease (ESRD) among atrial fibrillation (AF) patients.

Methods

We identified incident AF patients without CKD between 2000 and 2013 from the National Health Insurance Research Database (NHIRD) of Taiwan and calculated the CHA2DS2-VASc score for each patient. Adjusted hazard ratio (HR) with 95% confidence interval (CI) was estimated from multivariate cause-specific Cox models to assess the risk of CKD and ESRD associated with the CHA2DS2-VASc score.

Results

A total of 8764 participants with AF who did not have CKD were included in the analysis. The mean age was 69.63 ± 13.48 years and 4800 (54.8%) were males. The adjusted HR of CKD displayed a stepwise increase with the increase in the CHA2DS2-VASc score. When compared with those with a CHA2DS2-VASc score of 0, the adjusted HRs of CKD were 1.57 (95% CI 1.09–2.26), 2.04 (95% CI 1.42–2.94), 2.48 (95% CI 1.70–3.62), 2.88 (95% CI 1.95–4.26), 3.29 (95% CI 2.18–4.95) and 4.00 (95% CI 2.61–6.13) for the AF patients with a CHA2DS2-VASc score of 1, 2, 3, 4, 5 and ≥ 6, respectively. Similarly, as the CHA2DS2-VASc score increased, the adjusted HR of ESRD showed a gradual increase.

Conclusions

Patients with a higher CHA2DS2-VASc score were linked to a higher risk of CKD and ESRD in a dose-dependent effect, i.e. the incidence of CKD/ESRD increased with the increasing CHA2DS2-VASc score.

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Funding

This study was funded by Grants 106-CCH-IRP-029, 107-CCH-HCR-033 and 108-CCH-IRP-092 from the Changhua Christian Hospital Research Foundation. The funding sources had no role in the design or conduct or reporting of the study.

Author information

Author notes

  1. Chih-Jen Wang and Chew-Teng Kor contributed equally.

Authors and Affiliations

  1. Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan

    Chih-Jen Wang & Chew-Teng Kor

  2. Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan, R.O.C.

    Yao-Peng Hsieh & Ping-Fang Chiu

  3. School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yao-Peng Hsieh

  4. School of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Yao-Peng Hsieh & Ping-Fang Chiu

  5. Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan

    Ping-Fang Chiu

Authors
  1. Chih-Jen Wang
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  2. Yao-Peng Hsieh
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  3. Chew-Teng Kor
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  4. Ping-Fang Chiu
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Contributions

All authors listed have contributed sufficiently to the project to be included as authors and all those who are qualified to be authors are listed in the author by line. C-JW conceived and designed the experiments. C-TK analyzed the data. Y-PH wrote the original draft. P-FC reviewed and edited the paper.

Corresponding authors

Correspondence to Yao-Peng Hsieh or Ping-Fang Chiu.

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There is no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Electronic supplementary material

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11255_2020_2514_MOESM1_ESM.tif

Supplementary Figure 1. Cumulative incidence curves of chronic kidney disease in patients with different CHA2DS2-VASc scores (log-rank test, p<0.001). (TIF 919 kb)

11255_2020_2514_MOESM2_ESM.tif

Supplementary Figure 2. Cumulative incidence curves of end-stage renal disease in patients with different CHA2DS2-VASc scores (log-rank test, p<0.001). Supplementary file2 (TIF 919 kb)

11255_2020_2514_MOESM3_ESM.docx

Supplementary Table 1. ICD-9-CM codes used to identify atrial fibrillation, chronic kidney disease, end-stage renal disease and other comorbidities. (DOCX 17 kb)

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Wang, CJ., Hsieh, YP., Kor, CT. et al. The CHA2DS2-VASc score predicts chronic kidney disease among patients with atrial fibrillation. Int Urol Nephrol 52, 1523–1531 (2020). https://doi.org/10.1007/s11255-020-02514-x

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  • DOI: https://doi.org/10.1007/s11255-020-02514-x

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