title: Advanced chronic kidney disease in non-valvular atrial fibrillation: extending the utility of R2CHADS2 to patients with advanced renal failure.
abstract: BACKGROUND
  The R2CHADS2 is a new prediction rule for stroke risk in atrial fibrillation (AF) patients wherein R stands for renal risk. However, it was created from a cohort that excluded patients with advanced renal failure (defined as glomerular filtration rate of <30 mL/min). Our study extends the use of R2CHADS2 to patients with advanced renal failure and aims to compare its predictive power against the currently used CHADS and CHA2DS2VaSc.
  
  
  METHODS
  This retrospective cohort study analyzed the 1-year risk for stroke of the 524 patients with AF at Metropolitan Hospital Center. AUC and C statistics were calculated using three groups: (i) the entire cohort including patients with advanced renal failure, (ii) a cohort excluding patients with advanced renal failure and (iii) all patients with GFR < 30 mL/min only.
  
  
  RESULTS
  R2CHADS2, as a predictor for stroke risk, consistently performs better than CHADS2 and CHA2DS2VsC in groups 1 and 2. The C-statistic was highest in R2CHADS compared with CHADS or CHADSVASC in group 1 (0.718 versus 0.605 versus 0.602) and in group 2 (0.724 versus 0.584 versus 0.579). However, there was no statistically significant difference in group 3 (0.631 versus 0.629 versus 0.623).
  
  
  CONCLUSIONS
  Our study supports the utility of R2CHADS2 as a clinical prediction rule for stroke risk in patients with advanced renal failure.
authors: Department of Medicine , Metropolitan Hospital Center , New York, NY , USA.
authors: Josef
authors: J
authors: Bautista
authors: Department of Medicine , Metropolitan Hospital Center , New York, NY , USA.
authors: Archie
authors: A
authors: Bella
authors: Section of Nephrology, Department of Internal Medicine , Metropolitan Hospital Center, New York Medical College , New York, NY , USA.
authors: Ashok
authors: A
authors: Chaudhari
authors: Section of Cardiology, Department of Internal Medicine , Metropolitan Hospital Center, New York Medical College , New York, NY , USA.
authors: Gerald
authors: G
authors: Pekler
authors: Mailman School of Public Health , Columbia University , New York, NY , USA.
authors: Katherine J
authors: KJ
authors: Sapra
authors: Section of Nephrology, Department of Internal Medicine , Metropolitan Hospital Center, New York Medical College , New York, NY , USA.
authors: Roger
authors: R
authors: Carbajal
authors: Section of Nephrology, Department of Internal Medicine , Metropolitan Hospital Center, New York Medical College , New York, NY , USA.
authors: Donald
authors: D
authors: Baumstein
keywords: CKD; anticoagulation; atrial fibrillation; clinical prediction rule; stroke