title: Impact of moderate to severe renal impairment on long-term clinical outcomes in patients with atrial fibrillation.
abstract: The deleterious effect of renal impairment in non-valvular atrial fibrillation (AF) patients has recently been reported. We investigated the impact of moderate to severe renal impairment on long-term clinical outcomes in AF patients.
  
  
  
  A total of 2126 AF patients were enrolled and divided into two groups according to ≥ or <60mL/min estimated glomerular filtration rate (eGFR). Clinical outcomes including all-cause death, cardiac death, ischemic stroke (IS), bleeding, and admission for heart failure (HF) were analyzed.
  
  
  
  Compared to the ≥60mL/min eGFR group, <60mL/min eGFR patients were older; had a higher proportion of females; were more likely to have diabetes, hypertension, and history of stroke; and had higher CHADS2, CHA2DS2-VASc, and HAS-BLED scores. During the follow-up period (median 6.23 years), all-cause death, bleeding, admission for HF, and progression to persistent or permanent AF were significantly increased in the <60mL/min eGFR group compared to the ≥60mL/min eGFR group. After multivariate Cox regression analyses, <60mL/min eGFR increased the risk of all-cause death [hazard ratio (HR): 1.84; 95% confidence interval (CI): 1.03-3.28, p=0.04] and bleeding (HR: 1.28; 95% CI: 1.04-1.57, p=0.02). IS was only significantly increased in the <60mL/min eGFR group not receiving antithrombotic treatment.
  
  
  
  Moderate to severe renal impairment is a poor prognostic factor of long-term clinical outcomes in AF patients.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Hwang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kwang Jin
authors.initials: KJ
authors.lastname: Chun
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoung-Min
authors.initials: KM
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: June Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: yk.on@samsung.com.
authors.forename: Young Keun
authors.initials: YK
authors.lastname: On
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D002423:Cause of Death; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications
keywords: Atrial fibrillation; Bleeding; Renal impairment; Stroke