Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study.
Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study.
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DOI：
10.1161/circulationaha.108.816082
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发表时间：
2009-03-17
期刊：
影响因子：
37.8
通讯作者：
ATRIA Study Investigators
中科院分区：
文献类型：
--
作者：
Go AS;Fang MC;Udaltsova N;Chang Y;Pomernacki NK;Borowsky L;Singer DE;ATRIA Study Investigators
心房颤动（AF）显著增加缺血性卒中的风险，但这种风险在AF患者个体中存在差异。现有的风险分层方案预测能力有限。慢性肾脏疾病是一个主要的心血管危险因素，但它是否独立增加AF患者缺血性卒中的风险尚不清楚。我们研究了慢性肾脏疾病（肾小球滤过率降低或蛋白尿）如何影响AF患者抗凝治疗后血栓栓塞的风险。我们使用肾脏疾病饮食改良方程和实验室数据库中尿试纸结果的蛋白尿来估计肾小球滤过率（eGFR）。通过临床数据库确定患者特征、华法林使用和血栓栓塞事件，并通过病历审查确认血栓栓塞。在10，908例房颤患者中，在33，165人-年的抗凝治疗期间，我们观察到676例血栓栓塞事件。在校正了已知的中风危险因素和其他混杂因素后，蛋白尿使血栓栓塞的风险增加了54%（相对风险[RR] 1.54，1.29 - 1.85），与eGFR ≥60相比，eGFR水平逐渐降低，卒中风险分级增加（单位ml/min/1.73 m2）：eGFR 45 - 59的RR 1.16（95% CI：0.95 - 1.40），eGFR <45的RR 1.39（95% CI：1.13 - 1.71）（趋势P=0.0082）。.慢性肾脏疾病会增加房颤患者血栓栓塞的风险，与其他风险因素无关。了解肾功能水平和蛋白尿的存在可能会改善风险分层，以决定是否使用抗血栓治疗预防AF卒中。
Atrial fibrillation (AF) substantially increases the risk of ischemic stroke but this risk varies among individual patients with AF. Existing risk stratification schemes have limited predictive ability. Chronic kidney disease is a major cardiovascular risk factor, but whether it independently increases the risk for ischemic stroke in persons with AF is unknown. We examined how chronic kidney disease (reduced glomerular filtration rate or proteinuria) affects risk of thromboembolism off anticoagulation in patients with AF. We estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation and proteinuria from urine dipstick results found in laboratory databases. Patient characteristics, warfarin use, and thromboembolic events were ascertained from clinical databases, with validation of thromboembolism by chart review. During 33,165 person-years off anticoagulation among 10,908 patients with atrial fibrillation, we observed 676 incident thromboembolic events. After adjustment for known risk factors for stroke and other confounders, proteinuria increased the risk of thromboembolism by 54% (relative risk [RR] 1.54, 1.29 to 1.85) and there was a graded, increased risk of stroke associated with progressively lower level of eGFR compared with eGFR ≥60 (in units of ml/min/1.73 m2): RR 1.16 (95% CI: 0.95−1.40) for eGFR 45−59 and RR 1.39 (95% CI: 1.13−1.71) for eGFR <45 (P=0.0082 for trend). . Chronic kidney disease increases the risk of thromboembolism in AF independent of other risk factors. Knowing the level of kidney function and presence of proteinuria may improve risk stratification for decision-making about the use of antithrombotic therapy for stroke prevention in AF.