title: Risk of thromboembolic events in atrial fibrillation with chronic kidney disease.
abstract: OBJECTIVE
  Chronic kidney disease may increase the risk for ischemic stroke or systemic embolism in patients with nonvalular atrial fibrillation (AF). We conducted a meta-analysis to summarize all published studies to investigate the link between chronic kidney disease and risk of thromboembolic events in AF.
  
  
  METHODS
  We performed a literature search using MEDLINE (source PubMed, 1966 to July, 2014) and EMBASE (1980 to July 2014) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis.
  
  
  RESULTS
  Eighteen studies involving 538 479 patients and 41 719 incident thromboembolic events were identified. From the pooled analysis, AF patients with estimated glomerular filtration rate <60 mL/min compared with those with estimated glomerular filtration rate ≥60 mL/min experienced a significantly increased risk for developing thromboembolic events (relative risk, 1.62 [95% confidence interval, 1.40-1.87; P<0.001]). The annual rate of thromboembolic events increased by 0.41% (95% confidence interval, 0.17%-0.65%) for a 10 mL/min decrease in renal function. Addition of renal impairment to CHADS2 slightly improved the stroke risk stratification.
  
  
  CONCLUSIONS
  Impaired renal function is an independent predictor of stroke or systemic embolism in patients with nonvalvular AF. Consideration of renal function may improve stroke risk stratification in patients with AF.
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wu-Tao
authors.initials: WT
authors.lastname: Zeng
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiu-Ting
authors.initials: XT
authors.lastname: Sun
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Tang
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Mei
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Liu
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xu
authors.affiliation: From the Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. cheng831011@sina.com.
authors.forename: Yun-Jiu
authors.initials: YJ
authors.lastname: Cheng
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications*; D005919:Glomerular Filtration Rate; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology*; D013923:Thromboembolism / Q000209:etiology*
keywords: atrial fibrillation; chronic kidney disease; ischemic stroke