OBJECTIVE: To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). DESIGN: Observational prospective multicentre cohort study. SETTING:Atherothrombosis Center of I Clinica Medica of 'Sapienza' University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. PARTICIPANTS: 897 AF patients on treatment with vitamin K antagonists. MAIN OUTCOME MEASURES: The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m(2)/year, and incident eGFR<60 mL/min/1.73 m(2) were primary and secondary end points, respectively. RESULTS: Mean age was 71.8±9.0 years and 41.8% were women. Low ABI (ie, ≤0.90) was present in 194 (21.6%) patients. Baseline median eGFR was 72.7 mL/min/1.73 m(2), and 28.7% patients had an eGFR<60 mL/min/1.73 m(2). Annual decline of eGFR was -2.0 (IQR -7.4/-0.4) mL/min/1.73 m(2)/year, and 32.4% patients had a rapid decline in eGFR. Multivariable logistic regression analysis showed that ABI ≤0.90 (OR 1.516 (95% CI 1.075 to 2.139), p=0.018) and arterial hypertension (OR 1.830 95% CI 1.113 to 3.009, p=0.017) predicted a rapid eGFR decline, with an inverse association for angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (OR 0.662 95% CI 0.464 to 0.944, p=0.023). Among the 639 patients with AF with eGFR >60 mL/min/1.73 m(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). CONCLUSIONS: In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m(2). ABI measurement may help identify patients with AF at risk of renal function deterioration.
Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: A prospective multicentre cohort study / Violi, Francesco; Pastori, Daniele; Perticone, Francesco; Hiatt, William R.; Sciacqua, Angela; Basili, Stefania; Proietti, Marco; Corazza, Gino R.; Lip, Gregory Y. H.; Pignatelli, Pasquale; Cominacini, L; Mozzini, C; De Palma, D; Galderisi, M; Cudemo, G; Galletti, F; Fazio, V; Adinolfi, Le; Sellitto, A; Restivo, L; Cacciafesta, M; Gueli, N; Castellino, P; Curto, I; Vecchio, C; Sesti, G; Arturi, F; Grembiale, A; Perticone, F; Scarpino, Pe; Carullo, G; Vidili, G; Atzori, S; Delitala, G; Di Michele, D; Fava, A; Bertolotti, M; Mussi, C; De Luca, E; De Zaiacomo, F; Giantin, V; Corazza Gino, R; Miceli, E; Padula, D; Santovito, D; Cipollone, F; Andreozzi, P; Ettorre, E; Viscogliosi, G; Glorioso, N; Melis, G; Marras, G; Matta, M; Porta, M; Brizzi, Mf; Moroni, C; Valente, L; Lopreiato, F; Gentile, A; Catozzo, V; Rancan, E; Ageno, W; Guasti, L; Cangemi, R; Pignataro, Fs; Pastori, D; Ferro, D; Loffredo, L; Perri, L; Catasca, E; Raparelli, V; Napoleone, L; Tommaso, B; Francesco, B; Talerico, G; Calvieri, C; Vicario, T; Russo, R; Saliola, M; Del Ben, M; Angelico, F; Vestri, Ar; Farcomeni, A; Di Tanna, G; Davi, G; Basili, S; Mannucci, Pm; Perticone, F; Lip, Gy; Hiatt, W; Vestri, Ar; Corazza, Gr; Licata, G; Violi, F; Gobbi, P; Basili, S; Corrao, S.. - In: BMJ OPEN. - ISSN 2044-6055. - 5:5(2015), pp. e008026-e008026. [10.1136/bmjopen-2015-008026]
Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: A prospective multicentre cohort study
De Palma D;Galderisi M;Cudemo G;Galletti F;Fazio V;
2015
Abstract
OBJECTIVE: To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). DESIGN: Observational prospective multicentre cohort study. SETTING:Atherothrombosis Center of I Clinica Medica of 'Sapienza' University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. PARTICIPANTS: 897 AF patients on treatment with vitamin K antagonists. MAIN OUTCOME MEASURES: The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m(2)/year, and incident eGFR<60 mL/min/1.73 m(2) were primary and secondary end points, respectively. RESULTS: Mean age was 71.8±9.0 years and 41.8% were women. Low ABI (ie, ≤0.90) was present in 194 (21.6%) patients. Baseline median eGFR was 72.7 mL/min/1.73 m(2), and 28.7% patients had an eGFR<60 mL/min/1.73 m(2). Annual decline of eGFR was -2.0 (IQR -7.4/-0.4) mL/min/1.73 m(2)/year, and 32.4% patients had a rapid decline in eGFR. Multivariable logistic regression analysis showed that ABI ≤0.90 (OR 1.516 (95% CI 1.075 to 2.139), p=0.018) and arterial hypertension (OR 1.830 95% CI 1.113 to 3.009, p=0.017) predicted a rapid eGFR decline, with an inverse association for angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (OR 0.662 95% CI 0.464 to 0.944, p=0.023). Among the 639 patients with AF with eGFR >60 mL/min/1.73 m(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). CONCLUSIONS: In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m(2). ABI measurement may help identify patients with AF at risk of renal function deterioration.| File | Dimensione | Formato | |
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