Chronic Kidney Disease and Its Impact on a Prothrombotic State in Patients with Atrial Fibrillation

• Published in: Journal of clinical medicine Vol. 9; no. 8; p. 2476
• Main Authors: Matusik, Paweł T., Heleniak, Zbigniew, Papuga-Szela, Elżbieta, Plens, Krzysztof, Lelakowski, Jacek, Undas, Anetta
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01-08-2020; MDPI
• Subjects: Age; Cardiac arrhythmia; Clinical medicine; Diabetes; Embolisms; Equality; Heart failure; Hemodialysis; Hypertension; Kidney diseases; Laboratories; Permeability; Risk factors; Stroke; Transient ischemic attack; Values; Variables; United States > US; Germany
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9082476

It is unclear whether chronic kidney disease (CKD) increases thromboembolism in atrial fibrillation (AF). We conducted a retrospective cross-sectional analysis of 502 non-anticoagulated AF patients (median age, 66 (60–73) years, median CHA2DS2-VASc score, 3.0 (2.0–4.0)) with an estimated glomerular filtration rate (eGFR) ≥ 15 mL/min/1.73 m2. Endogenous thrombin potential (ETP), clot permeability (Ks), and clot lysis time (CLT), among others, were determined. Patients with stage 4 CKD (n = 87; 17.3%) had higher ETP and prolonged CLT compared with those with stage 3 CKD. In patients with stages 3 to 4 CKD (n = 180; 35.9%) N-terminal pro-B-type natriuretic peptide predicted low Ks (the lowest quartile, odds ratio [OR] per 100 pg/mL: 1.03, 95% confidence interval [CI]: 1.01–1.06) and prolonged CLT (the top quartile, OR per 100 pg/mL: 1.05, 95% CI: 1.02–1.08), but not high ETP. In the whole cohort, after adjustment for CHA2DS2-VASc score, stage 4 CKD, but not stage 3 CKD, predicted high ETP (OR: 9.06; 95% CI: 4.44−18.46) and prolonged CLT (OR: 3.58; 95% CI: 1.76–7.28), but not low Ks. compared to the reference eGFR category. This study is the first to demonstrate the prothrombotic and antifibrinolytic alterations in AF patients with stage 4 CKD, but not stage 3 CKD irrespective of clinical stroke risk factors.