학술논문
Changes in estimated glomerular filtration rate before and after the first visit for atrial fibrillation
Document Type
Report
Author
Source
BMC Nephrology. January 3, 2024, Vol. 25 Issue 1
Subject
Language
English
ISSN
1471-2369
Abstract
Author(s): Ryobun Yasuoka[sup.1] , Hiroyuki Sakurane[sup.1] , Mana Okune[sup.1] , Motohide Tanaka[sup.1] , Tomoya Nagano[sup.2] , Masahiro Maruyama[sup.1] , Gaku Nakazawa[sup.1] and Takashi Kurita[sup.1] Introduction Several investigators have reported that [...]
Background Although the development of atrial fibrillation (AF) and the progression of chronic kidney disease are known to be interrelated, it remains unclear when and how renal function changes during the clinical course of AF. Methods This study retrospectively enrolled 131 patients who were able to collect data on estimated glomerular filtration rate (eGFR) at least five times during the 500 days before and 500 days after the first visit (baseline) of new-onset AF, respectively. To investigate the temporal relationship between the development of AF and the beginning of worsening renal function (WRF), a piecewise regression model was applied to the eGFR time series data. The time point at which the slopes of the two regression lines changed (inflection -point), the slope before and after the inflection-point ([beta]1 and [beta]2, respectively), and the difference in slope ([DELA][beta]) were estimated. The presence of WRF was defined as having the inflection-point at which both [DELA][beta] and [beta]2 were < - 0.0083 mL/min/1.73 m.sup.2/day (corresponding to 3.03 mL/min/1.73 m.sup.2/year), and the corresponding the inflection-point was defined as the beginning of WRF. Results WRF was detected in 54 (41.2%) patients. The beginning of WRF were distributed at various times, but most frequently (23 of 54 patients) within 100 days before and after baseline. The presence of WRF was not associated with age, heart failure, or baseline eGFR, but was associated with positive [beta]1 (odds ratio 30.5, 95% confidence interval 11.1-83.9, P < 0.01). Conclusion In nearly half of AF patients with WRF, the beginning of WRF was observed within a few months before or after the first visit for AF. Patients with a positive eGFR slope before the onset of AF are more likely to develop WRF after the onset of AF, suggesting that potential kidney damage may be underlying. Keywords: Atrial fibrillation, Worsening renal function, Inflection-point
Background Although the development of atrial fibrillation (AF) and the progression of chronic kidney disease are known to be interrelated, it remains unclear when and how renal function changes during the clinical course of AF. Methods This study retrospectively enrolled 131 patients who were able to collect data on estimated glomerular filtration rate (eGFR) at least five times during the 500 days before and 500 days after the first visit (baseline) of new-onset AF, respectively. To investigate the temporal relationship between the development of AF and the beginning of worsening renal function (WRF), a piecewise regression model was applied to the eGFR time series data. The time point at which the slopes of the two regression lines changed (inflection -point), the slope before and after the inflection-point ([beta]1 and [beta]2, respectively), and the difference in slope ([DELA][beta]) were estimated. The presence of WRF was defined as having the inflection-point at which both [DELA][beta] and [beta]2 were < - 0.0083 mL/min/1.73 m.sup.2/day (corresponding to 3.03 mL/min/1.73 m.sup.2/year), and the corresponding the inflection-point was defined as the beginning of WRF. Results WRF was detected in 54 (41.2%) patients. The beginning of WRF were distributed at various times, but most frequently (23 of 54 patients) within 100 days before and after baseline. The presence of WRF was not associated with age, heart failure, or baseline eGFR, but was associated with positive [beta]1 (odds ratio 30.5, 95% confidence interval 11.1-83.9, P < 0.01). Conclusion In nearly half of AF patients with WRF, the beginning of WRF was observed within a few months before or after the first visit for AF. Patients with a positive eGFR slope before the onset of AF are more likely to develop WRF after the onset of AF, suggesting that potential kidney damage may be underlying. Keywords: Atrial fibrillation, Worsening renal function, Inflection-point