Future cardiology · 2014
Prevalence of renal dysfunction according to the type of atrial fibrillation and anticoagulation treatment in patients who attended primary care in Spain.
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Barrios Vivencio, Escobar Carlos, Calderón Alberto, Zamorano Jose L
Аннотация
AIM: To determine the prevalence of renal dysfunction according to the type of atrial fibrillation (AF) and anticoagulation treatment in patients attended in primary care in Spain. METHODS & PARTICIPANTS: The VAL-FAAP study was a national, descriptive, epidemiological and cross-sectional study that included patients of both sexes, ≥18 years of age, with a previous diagnosis of AF by an ECG, attended in a primary-care setting. Renal function was defined by estimated glomerular filtration rate (eGFR), calculated by the modification of diet in renal disease-4 formula.
RESULTS: A total of 3287 patients with atrial fibrillation were included (mean age: 71.9 ± 10.1 years; 52.3% male). Overall, 31.6% of patients had an eGFR <60 ml/min/1.73m(2) and 1.6% <30 ml/min/1.73m(2). The proportion of patients with permanent AF increased as the eGFR decreased. Similarly, as congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke (doubled), vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) increased, chronic kidney disease was more frequent. A third of patients with CHA2DS2-VASc ≥2 had moderate renal dysfunction; however, 35.5% of them did not receive anticoagulants (compared with 31.5% of those with CHA2DS2-VASc ≥2 and normal renal function).
CONCLUSION: Chronic kidney disease is common in patients with AF, particularly in those patients with permanent AF or CHA2DS2-VASc ≥2. Although indicated, 35.5% of patients with AF, a CHA2DS2-VASc ≥2 and moderate renal dysfunction did not receive appropriate anticoagulation, despite the high risk of stroke.
RESULTS: A total of 3287 patients with atrial fibrillation were included (mean age: 71.9 ± 10.1 years; 52.3% male). Overall, 31.6% of patients had an eGFR <60 ml/min/1.73m(2) and 1.6% <30 ml/min/1.73m(2). The proportion of patients with permanent AF increased as the eGFR decreased. Similarly, as congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke (doubled), vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) increased, chronic kidney disease was more frequent. A third of patients with CHA2DS2-VASc ≥2 had moderate renal dysfunction; however, 35.5% of them did not receive anticoagulants (compared with 31.5% of those with CHA2DS2-VASc ≥2 and normal renal function).
CONCLUSION: Chronic kidney disease is common in patients with AF, particularly in those patients with permanent AF or CHA2DS2-VASc ≥2. Although indicated, 35.5% of patients with AF, a CHA2DS2-VASc ≥2 and moderate renal dysfunction did not receive appropriate anticoagulation, despite the high risk of stroke.