Background-—Using data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD–Atrial Fibrillation), we evaluated the impact of chronic kidney disease (CKD) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation (AF). Methods and Results-—GARFIELD-AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate-to-severe CKD, based on the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate-to-severe CKD, 16.9% (n=5595) mild CKD, and 72.1% (n=23 816) no CKD. The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA2DS2-VASc score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate-to-severe CKD were independent risk factors for all-cause mortality. Moderate-to-severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new-onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate-to-severe CKD on mortality was significantly greater in patients from Asia than the rest of the world (P=0.001). Conclusions-—In GARFIELD-AF, moderate-to-severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate-to-severe CKD on mortality was even greater in patients from Asia than the rest of the world.
Bibliographical noteFunding Information:
This work was supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, United Kingdom), which sponsors the GARFIELD-AF registry.
Dr Goto received significant research funding from Sanofi, Pfizer, Ono, and Bristol-Myers Squibb. Dr Goto received a modest personal fee from Bayer and AstraZeneca. Shinya Goto is an associate Editor for Circulation, an associate Editor for Journal of Biorheology, an associate Editor for Archives of Medical Science, and section Editor for Thrombosis and Hemostasis. Angchaisuksiri has nothing to disclose. Dr Camm reports personal fees from Bayer, Boehringer Ingelheim, Pfizer/BMS, and Daiichi Sankyo, outside the submitted work. Mr Gibbs reports personal fees from Pfizer, Bayer, and Boehringer Ingelheim BF; and speakers’ fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, and BMS/Pfizer. Dr Goldhaber reports research grants from BiO2 Medical, Boehringer-Ingelheim, BMS, BTG EKOS, Daiichi, Janssen, NHLBI, and Thrombosis Research Institute; and personal fees from Agile, Bayer, Boehringer-Ingelheim, BMS, Daiichi, Janssen, Portola, and Zafgen. Dr Jing reports receiving personal fees from Bayer AG, Actelion, Pfizer, and United Therapeutics. Dr Haas reports personal fees and advisory board from Bayer AG, Bristol-Myers Squibb, Daiichi-Sankyo, and Sanofi; and received honoraria from Aspen, Bayer Healthcare, Bristol-Myers Squibb, Daiichi-Sankyo, and Pfizer. Ms Kayani reports grants from Bayer AG during the conduct of the study. Dr Koretsune reports research grants from Daiichi Sankyo and Boehringer Ingelheim; and paid lectures for Daiichi Sankyo, Boehringer Ingelheim, Bayer, Bristol Meyers, and Pfizer. Dr Lim reports personal fees from Pfizer/BMS, personal fees from Bayer, grants and personal fees from Medtronic, personal fees from St Jude Medical, personal fees from Biotronik, and grants from Boehringer-Ingelheim, outside the submitted work. Dr Oh has received consultant/advisory board payments for Bayer Pharma AG, Bristol-Myers Squibb Korea, Boehringer-Ingelheim Korea, Pfizer Korea, Sanofi-Aventis, and St Jude Medical, outside the submitted work. Dr Sawhney reports personal fees from Pfizer, Astra Zeneca, Novartis, Sanofi, and Bristol-Myers Squibb. Dr Turpie has received personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Astellas, Portola, and Takeda. Dr van Eickels is an employee of Bayer AG. Dr Verheugt reports grants and personal fees from Bayer Healthcare, and personal fees from BMS/Pfizer, Daiichi-Sankyo, and Boehringer-Ingel-heim, outside the submitted work. Dr Kakkar reports grants from Bayer AG during the conduct of the study; grants and personal fees from Bayer AG, and personal fees from Boehringer-Ingelheim Pharma, Daiichi Sankyo Europe, Janssen Pharma, Sanofi SA, and Verseon outside the submitted work. The remaining authors have no disclosures to report.
© 2019 The Authors.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine