Clinical outcomes and predictors of long-term mortality, hemorrhagic and thromboembolic events in atrial fibrillation patients at different stages of chronic kidney disease: The CRAFT trial

Abstract

Background Chronic kidney disease (CKD) coexisting with atrial fibrillation (AF) increases the risk of hemorrhage and ischemia. The study aimed to determine the relationship between different CKD stages and clinical outcomes of patients suffering from both CKD and AF and to determine the predictors of outcome. Methods The data was derived from multicenter CRAFT trial (NCT02987062). We have conducted a retrospective analysis of hospital records of 2663 AF patients divided in three groups according to their estimated glomerular filtration rate (eGFR) which was <30ml/min/1,73 m2 for group I (n=63), ≥30 and <60 ml/min/1,73 m2 for group II (n=947) and ≥60 ml/min/1,73 m2 for group III (n=1653). The primary study endpoint was major adverse event (MAE) during the mean four-year follow-up. Results The highest rate of MAE was observed in group I followed by group II and III. The rate of all-cause death was 60% in group I, 32% in group II and 15% in group III (p<0.001). Bleeding complications occurred in 25% of patients from group I, 23% from group II and 21% from group III (p=0.14). Thromboembolic events occurred in those groups at the rate of 21%, 14% and 12% respectively (p=0.011). The risk of death was 5 times higher in patients with eGFR<30 treated with vitamin K antagonists (VKA) (HR: 5.016, 95% CI: 1.533-16.417; p=0.007). Conclusions AF patients with CKD are at higher risk of MAE and that risk depends on the CKD stage. VKA treatment was linked to a higher mortality in AF patients with the lowest eGFR values.

Keywords

• Atrial fibrillation
• Bleeding
• Chronic kidney disease
• Ischemia
• Survival