title: Meta-analysis of the influence of chronic kidney disease on the risk of thromboembolism among patients with nonvalvular atrial fibrillation.
abstract: Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist. However, the extent to which CKD increases the risk of thromboembolism in patients with nonvalvular AF and the benefits of anticoagulation in this group remain unclear. We addressed the role of CKD in the prediction of thromboembolic events and the impact of anticoagulation using a meta-analysis method. Data sources included MEDLINE, EMBASE, and Cochrane (from inception to January 2014). Three independent reviewers selected studies. Descriptive and quantitative information was extracted from each selected study and a random-effects meta-analysis was performed. After screening 962 search results, 19 studies were considered eligible. Among patients with AF, the presence of CKD resulted in an increased risk of thromboembolism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.20 to 1.76, p = 0.0001), particularly in case of end-stage CKD (HR 1.83, 95% CI 1.56 to 2.14, p <0.00001). Warfarin decreased the incidence of thromboembolic events in patients with non-end-stage CKD (HR 0.39, 95% CI 0.18 to 0.86, p <0.00001). Recent data on novel oral anticoagulants suggested a higher efficacy of these agents compared with warfarin (HR 0.80, 95% CI 0.66 to 0.96, p = 0.02) and aspirin (HR 0.32, 95% CI 0.19 to 0.55, p <0.0001) in treating non-end-stage CKD. In conclusion, the presence of CKD in patients with AF is associated with an almost 50% increased thromboembolic risk, which can be effectively decreased with appropriate antithrombotic therapy. Further prospective studies are needed to better evaluate the interest of anticoagulation in patients with severe CKD.
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France; Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address: rui_providencia@yahoo.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: Paris Descartes University and European Georges Pompidou Hospital, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.affiliation: Paris Descartes University and European Georges Pompidou Hospital, Paris, France; Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: Paris Descartes University and European Georges Pompidou Hospital, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications*; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*