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Clinical outcomes associated with kidney function changes in anticoagulated atrial fibrillation patients: An ancillary analysis from the BOREALIS trial.

ABSTRACT: Background:Patients with atrial fibrillation (AF) and chronic kidney disease represent a high-risk group for thromboembolism and bleeding. Aims:To explore the relationship between kidney function changes and outcomes of stroke/systemic embolism (SE), major bleeding and all-cause death in anticoagulated AF patients participating in the BOREALIS trial comparing efficacy and safety of once-weekly s.c. idrabiotaparinux to that of warfarin. Methods:Changes in kidney function by estimated glomerular filtration rate (eGFR) were calculated using the Chronic Kidney Disease Epidemiology Collaboration equation in 2765 AF patients. Trial adjudicated outcomes were determined. Results:After a mean follow-up of 394 days, in 94.4% of the included patients kidney function changed ranging from -30 mL/min to 30 mL/min. The incidence of stroke/SE and major bleeding was similar between patients with deteriorated (reduction in eGFR from baseline over follow-up) and preserved kidney function change (increase or no change in eGFR from baseline over follow-up) [stroke/SE: incidence rate (IR): 1.33%/year vs 1.80%/year; hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.41-1.32, P = .30; major bleeding: IR 1.63%/year vs 1.49%/year, HR 1.10, 95% CI 0.61-1.97, P = .76]. On Cox regression analysis, patients with deteriorated kidney function were at higher risk for all-cause death, compared to patients with preserved kidney function (HR: 1.64, 95% CI: 1.02-2.63, P = .04). Conclusion:In the BOREALIS trial, the risk of adjudicated stroke/SE, major bleedings, and all-cause death was not related to mild-moderate follow-up changes in kidney function (±30 mL/min). The risk of all-cause death was significantly increased in AF patients with abruptly deteriorating kidney function.

SUBMITTER: Bai Y

PROVIDER: S-EPMC7132193 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Clinical outcomes associated with kidney function changes in anticoagulated atrial fibrillation patients: An ancillary analysis from the BOREALIS trial.

Bai Ying Y Shantsila Alena A Lip Gregory Y H GYH

Journal of arrhythmia 20200206 2

<h4>Background</h4>Patients with atrial fibrillation (AF) and chronic kidney disease represent a high-risk group for thromboembolism and bleeding.<h4>Aims</h4>To explore the relationship between kidney function changes and outcomes of stroke/systemic embolism (SE), major bleeding and all-cause death in anticoagulated AF patients participating in the BOREALIS trial comparing efficacy and safety of once-weekly s.c. idrabiotaparinux to that of warfarin.<h4>Methods</h4>Changes in kidney function by ...[more]

PMID: 32256875

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Project description:BackgroundPostoperative atrial fibrillation (POAF) occurs in 30% to 50% of patients undergoing cardiac surgery and is associated with increased morbidity and mortality. Prospective identification of structural/molecular changes in atrial myocardium that correlate with myocardial injury and precede and predict risk of POAF may identify new molecular pathways and targets for prevention of this common morbid complication.MethodsRight atrial appendage samples were prospectively collected during cardiac surgery from 239 patients enrolled in the OPERA trial (Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation), fixed in 10% buffered formalin, and embedded in paraffin for histology. We assessed general tissue morphology, cardiomyocyte diameters, myocytolysis (perinuclear myofibril loss), accumulation of perinuclear glycogen, interstitial fibrosis, and myocardial gap junction distribution. We also assayed NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-cTnT, CRP (C-reactive protein), and circulating oxidative stress biomarkers (F2-isoprostanes, F3-isoprostanes, isofurans) in plasma collected before, during, and 48 hours after surgery. POAF was defined as occurrence of postcardiac surgery atrial fibrillation or flutter of at least 30 seconds duration confirmed by rhythm strip or 12-lead ECG. The follow-up period for all arrhythmias was from surgery until hospital discharge or postoperative day 10.ResultsThirty-five percent of patients experienced POAF. Compared with the non-POAF group, they were slightly older and more likely to have chronic obstructive pulmonary disease or heart failure. They also had a higher European System for Cardiac Operative Risk Evaluation and more often underwent valve surgery. No differences in left atrial size were observed between patients with POAF and patients without POAF. The extent of atrial interstitial fibrosis, cardiomyocyte myocytolysis, cardiomyocyte diameter, glycogen score or Cx43 distribution at the time of surgery was not significantly associated with incidence of POAF. None of these histopathologic abnormalities were correlated with levels of NT-proBNP, hs-cTnT, CRP, or oxidative stress biomarkers.ConclusionsIn sinus rhythm patients undergoing cardiac surgery, histopathologic changes in the right atrial appendage do not predict POAF. They also do not correlate with biomarkers of cardiac function, inflammation, and oxidative stress. Graphic Abstract: A graphic abstract is available for this article.

Dataset Information

Clinical outcomes associated with kidney function changes in anticoagulated atrial fibrillation patients: An ancillary analysis from the BOREALIS trial.

Publications

Clinical outcomes associated with kidney function changes in anticoagulated atrial fibrillation patients: An ancillary analysis from the BOREALIS trial.

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