title: Morbidity and treatment in patients with atrial fibrillation and chronic kidney disease.
abstract: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality but there are few studies available about atrial fibrillation, the most frequent arrhythmia in CKD, and the applied treatment. Based on the prospective German Competence NETwork on Atrial Fibrillation, data of 3138 patients with atrial fibrillation were analyzed and categorized by their estimated glomerular filtration rate (stages 1-3 and 4 plus 5). With advanced CKD, significantly more patients suffered from a more severe form of atrial fibrillation. Despite significantly higher CHADS2 scores in advanced CKD, oral anticoagulation was not prescribed more frequently while antiarrhythmic drugs and catheter ablations were used significantly less often, in contrast to more pacemaker implantations. However, in multivariate hierarchical logistic regression analyses of in-hospital treatments and complications, only hemorrhages and pacemaker implantations turned out to be independently and significantly associated with higher CKD stages. This nationwide study shows that patients with CKD and atrial fibrillation suffer from a markedly higher comorbidity. Thus, while CKD patients have received cardioversions, ablations, antiarrhythmic, or anticoagulation drugs significantly less often in their history, current treatments were not different if adjusted for multiple comorbidities. This might indicate an improvement in the often reported therapeutic nihilism in CKD.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital of Muenster, Muenster, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.affiliation: Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Nabauer
authors.affiliation: Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gerth
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Limbourg
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Andras
authors.initials: A
authors.lastname: Treszl
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital of Muenster, Muenster, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Engelbertz
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital of Muenster, Muenster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: 1] University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK [2] Department of Cardiovascular Medicine, University Hospital of Muenster, Muenster, Germany.
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Department of Pharmacology and Toxicology, Medical Faculty, Dresden University of Technology, Dresden, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Ravens
authors.affiliation: Department of Interventional Cardiology, Hamburg University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.affiliation: Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital of Muenster, Muenster, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*