Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients
The interaction between full-spectrum chronic kidney disease (CKD) and atrial fibrillation (AF) on ischemic stroke and all-cause mortality risk, particularly in stage 4 and 5 CKD, remains undetermined. This matched cohort study identified incident AF patients using the International Classification o...
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| Veröffentlicht in: | Atherosclerosis 2025-02, Vol.401, p.119055, Article 119055 |
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| creator | Chang, David Ray Chiang, Hsiu-Yin Hsiao, Ya-Luan Le, Uyen-Minh Hong, Yu-Cuyan Chang, Shih-Sheng Chen, Ke-Wei Lin, Che-Chen Yeh, Hung-Chieh Ting, I-Wen Chen, Pei-Chun Chen, Hung-Lin Chang, Kuan-Cheng Kuo, Chin-Chi |
| description | The interaction between full-spectrum chronic kidney disease (CKD) and atrial fibrillation (AF) on ischemic stroke and all-cause mortality risk, particularly in stage 4 and 5 CKD, remains undetermined.
This matched cohort study identified incident AF patients using the International Classification of Disease codes and electrocardiograms from the Clinical Research Data Repository of China Medical University Hospital between 2003 and 2020. For each AF patient, we selected four controls without AF and matched them by age, sex, eGFR within 10 mL/min/1.73 m2, end-stage kidney disease (ESKD) vintage, and diagnosis year. Multivariable Cox proportional hazard models were utilized to assess the interaction between AF and CKD on three-year ischemic stroke and all-cause mortality outcomes.
Within a total of 10,155 patients and 39,439 controls, incidence rates were 3.03 % and 1.48 % for ischemic stroke and 15.6 % and 9.53 % for overall mortality, respectively. In AF, the stroke risk was the highest among patients with stage 4 and 5-ND (non-dialysis) CKD with adjusted hazard ratio (aHR) of 3.31 (95 % CI, 2.46–4.45) and 2.73 (1.88–3.96), respectively. The mortality risk difference varied between 45% and 177 % with the highest difference noted in ESKD (aHR 3.36 [95 % CI, 2.84–3.98] in AF vs. 1.59 [95 % CI, 1.28–1.96] in non-AF; interaction p |
| doi_str_mv | 10.1016/j.atherosclerosis.2024.119055 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3146582679</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0021915024012279</els_id><sourcerecordid>3146582679</sourcerecordid><originalsourceid>FETCH-LOGICAL-c259t-1eb504c43f9b994317ea4c253bd21d8fcc740aed183cd645dda9dbd5376bb8c63</originalsourceid><addsrcrecordid>eNqNkcGOFCEQhonRuLOrr2C4mHiwR2iguzHxYDa6brLGi54JXVRnmO2BEWjNvIjPK7MzevBkQiApvv-vVP2EvORszRnv3mzXtmwwxQzz8fZ53bJWrjnXTKlHZMWHXjdcDvIxWTHW8kZzxS7IZc5bxpjs-fCUXAjdyb5VYkV-3YaCyULxMdARy0_EQGGTYvBA770LeKDOZ7QZqQ2O2pK8nenkx-Tn2T7I6vEBvMNQaC4p3p_ReW7ALlW4i6nY2ZfDW_rZFtigoxA3tVjxxR1onKjUr5WWdF8dq01-Rp5Mds74_PxekW8fP3y9_tTcfbm5vX5_10CrdGk4jopJkGLSo9ZS8B6trF9idC13wwTQS2bR8UGA66Ryzmo3OiX6bhwH6MQVeXXy3af4fcFczM5nwDpZwLhkI7js1NB2va7ouxMKde054WT2ye9sOhjOzDEaszX_RGOO0ZhTNFX_4txqGXfo_qr_ZFGBmxOAdeAfHpPJUJcB6HxCKMZF_5-tfgO_5a0A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3146582679</pqid></control><display><type>article</type><title>Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients</title><source>Elsevier ScienceDirect Journals</source><creator>Chang, David Ray ; Chiang, Hsiu-Yin ; Hsiao, Ya-Luan ; Le, Uyen-Minh ; Hong, Yu-Cuyan ; Chang, Shih-Sheng ; Chen, Ke-Wei ; Lin, Che-Chen ; Yeh, Hung-Chieh ; Ting, I-Wen ; Chen, Pei-Chun ; Chen, Hung-Lin ; Chang, Kuan-Cheng ; Kuo, Chin-Chi</creator><creatorcontrib>Chang, David Ray ; Chiang, Hsiu-Yin ; Hsiao, Ya-Luan ; Le, Uyen-Minh ; Hong, Yu-Cuyan ; Chang, Shih-Sheng ; Chen, Ke-Wei ; Lin, Che-Chen ; Yeh, Hung-Chieh ; Ting, I-Wen ; Chen, Pei-Chun ; Chen, Hung-Lin ; Chang, Kuan-Cheng ; Kuo, Chin-Chi</creatorcontrib><description>The interaction between full-spectrum chronic kidney disease (CKD) and atrial fibrillation (AF) on ischemic stroke and all-cause mortality risk, particularly in stage 4 and 5 CKD, remains undetermined.
This matched cohort study identified incident AF patients using the International Classification of Disease codes and electrocardiograms from the Clinical Research Data Repository of China Medical University Hospital between 2003 and 2020. For each AF patient, we selected four controls without AF and matched them by age, sex, eGFR within 10 mL/min/1.73 m2, end-stage kidney disease (ESKD) vintage, and diagnosis year. Multivariable Cox proportional hazard models were utilized to assess the interaction between AF and CKD on three-year ischemic stroke and all-cause mortality outcomes.
Within a total of 10,155 patients and 39,439 controls, incidence rates were 3.03 % and 1.48 % for ischemic stroke and 15.6 % and 9.53 % for overall mortality, respectively. In AF, the stroke risk was the highest among patients with stage 4 and 5-ND (non-dialysis) CKD with adjusted hazard ratio (aHR) of 3.31 (95 % CI, 2.46–4.45) and 2.73 (1.88–3.96), respectively. The mortality risk difference varied between 45% and 177 % with the highest difference noted in ESKD (aHR 3.36 [95 % CI, 2.84–3.98] in AF vs. 1.59 [95 % CI, 1.28–1.96] in non-AF; interaction p < 0.001). Anticoagulation therapy significantly lowered the mortality risk among patients with AF and advanced CKD (3-way interaction p < 0.001).
The risk of ischemic stroke and overall mortality was particularly high among patients with concurrent AF and stage 4 and 5-ND CKD, underscoring the urgent evidence to optimize prognosis.
[Display omitted]
•The highest risk of ischemic stroke and bleeding is observed in AF patients with stage 4 and 5 CKD, respectively.•AF and CKD mutually escalate the risk of all-cause mortality, reaching a peak in ESKD patients.•Anticoagulation use modifies the association pattern between AF and CKD, offsetting the risk of AF on all-cause mortality.</description><identifier>ISSN: 0021-9150</identifier><identifier>ISSN: 1879-1484</identifier><identifier>EISSN: 1879-1484</identifier><identifier>DOI: 10.1016/j.atherosclerosis.2024.119055</identifier><identifier>PMID: 39647253</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>All-cause mortality ; Atrial fibrillation ; Chronic kidney disease ; Ischemic stroke</subject><ispartof>Atherosclerosis, 2025-02, Vol.401, p.119055, Article 119055</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c259t-1eb504c43f9b994317ea4c253bd21d8fcc740aed183cd645dda9dbd5376bb8c63</cites><orcidid>0000-0002-2050-1377</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.atherosclerosis.2024.119055$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39647253$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, David Ray</creatorcontrib><creatorcontrib>Chiang, Hsiu-Yin</creatorcontrib><creatorcontrib>Hsiao, Ya-Luan</creatorcontrib><creatorcontrib>Le, Uyen-Minh</creatorcontrib><creatorcontrib>Hong, Yu-Cuyan</creatorcontrib><creatorcontrib>Chang, Shih-Sheng</creatorcontrib><creatorcontrib>Chen, Ke-Wei</creatorcontrib><creatorcontrib>Lin, Che-Chen</creatorcontrib><creatorcontrib>Yeh, Hung-Chieh</creatorcontrib><creatorcontrib>Ting, I-Wen</creatorcontrib><creatorcontrib>Chen, Pei-Chun</creatorcontrib><creatorcontrib>Chen, Hung-Lin</creatorcontrib><creatorcontrib>Chang, Kuan-Cheng</creatorcontrib><creatorcontrib>Kuo, Chin-Chi</creatorcontrib><title>Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients</title><title>Atherosclerosis</title><addtitle>Atherosclerosis</addtitle><description>The interaction between full-spectrum chronic kidney disease (CKD) and atrial fibrillation (AF) on ischemic stroke and all-cause mortality risk, particularly in stage 4 and 5 CKD, remains undetermined.
This matched cohort study identified incident AF patients using the International Classification of Disease codes and electrocardiograms from the Clinical Research Data Repository of China Medical University Hospital between 2003 and 2020. For each AF patient, we selected four controls without AF and matched them by age, sex, eGFR within 10 mL/min/1.73 m2, end-stage kidney disease (ESKD) vintage, and diagnosis year. Multivariable Cox proportional hazard models were utilized to assess the interaction between AF and CKD on three-year ischemic stroke and all-cause mortality outcomes.
Within a total of 10,155 patients and 39,439 controls, incidence rates were 3.03 % and 1.48 % for ischemic stroke and 15.6 % and 9.53 % for overall mortality, respectively. In AF, the stroke risk was the highest among patients with stage 4 and 5-ND (non-dialysis) CKD with adjusted hazard ratio (aHR) of 3.31 (95 % CI, 2.46–4.45) and 2.73 (1.88–3.96), respectively. The mortality risk difference varied between 45% and 177 % with the highest difference noted in ESKD (aHR 3.36 [95 % CI, 2.84–3.98] in AF vs. 1.59 [95 % CI, 1.28–1.96] in non-AF; interaction p < 0.001). Anticoagulation therapy significantly lowered the mortality risk among patients with AF and advanced CKD (3-way interaction p < 0.001).
The risk of ischemic stroke and overall mortality was particularly high among patients with concurrent AF and stage 4 and 5-ND CKD, underscoring the urgent evidence to optimize prognosis.
[Display omitted]
•The highest risk of ischemic stroke and bleeding is observed in AF patients with stage 4 and 5 CKD, respectively.•AF and CKD mutually escalate the risk of all-cause mortality, reaching a peak in ESKD patients.•Anticoagulation use modifies the association pattern between AF and CKD, offsetting the risk of AF on all-cause mortality.</description><subject>All-cause mortality</subject><subject>Atrial fibrillation</subject><subject>Chronic kidney disease</subject><subject>Ischemic stroke</subject><issn>0021-9150</issn><issn>1879-1484</issn><issn>1879-1484</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><recordid>eNqNkcGOFCEQhonRuLOrr2C4mHiwR2iguzHxYDa6brLGi54JXVRnmO2BEWjNvIjPK7MzevBkQiApvv-vVP2EvORszRnv3mzXtmwwxQzz8fZ53bJWrjnXTKlHZMWHXjdcDvIxWTHW8kZzxS7IZc5bxpjs-fCUXAjdyb5VYkV-3YaCyULxMdARy0_EQGGTYvBA770LeKDOZ7QZqQ2O2pK8nenkx-Tn2T7I6vEBvMNQaC4p3p_ReW7ALlW4i6nY2ZfDW_rZFtigoxA3tVjxxR1onKjUr5WWdF8dq01-Rp5Mds74_PxekW8fP3y9_tTcfbm5vX5_10CrdGk4jopJkGLSo9ZS8B6trF9idC13wwTQS2bR8UGA66Ryzmo3OiX6bhwH6MQVeXXy3af4fcFczM5nwDpZwLhkI7js1NB2va7ouxMKde054WT2ye9sOhjOzDEaszX_RGOO0ZhTNFX_4txqGXfo_qr_ZFGBmxOAdeAfHpPJUJcB6HxCKMZF_5-tfgO_5a0A</recordid><startdate>20250201</startdate><enddate>20250201</enddate><creator>Chang, David Ray</creator><creator>Chiang, Hsiu-Yin</creator><creator>Hsiao, Ya-Luan</creator><creator>Le, Uyen-Minh</creator><creator>Hong, Yu-Cuyan</creator><creator>Chang, Shih-Sheng</creator><creator>Chen, Ke-Wei</creator><creator>Lin, Che-Chen</creator><creator>Yeh, Hung-Chieh</creator><creator>Ting, I-Wen</creator><creator>Chen, Pei-Chun</creator><creator>Chen, Hung-Lin</creator><creator>Chang, Kuan-Cheng</creator><creator>Kuo, Chin-Chi</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2050-1377</orcidid></search><sort><creationdate>20250201</creationdate><title>Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients</title><author>Chang, David Ray ; Chiang, Hsiu-Yin ; Hsiao, Ya-Luan ; Le, Uyen-Minh ; Hong, Yu-Cuyan ; Chang, Shih-Sheng ; Chen, Ke-Wei ; Lin, Che-Chen ; Yeh, Hung-Chieh ; Ting, I-Wen ; Chen, Pei-Chun ; Chen, Hung-Lin ; Chang, Kuan-Cheng ; Kuo, Chin-Chi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c259t-1eb504c43f9b994317ea4c253bd21d8fcc740aed183cd645dda9dbd5376bb8c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>All-cause mortality</topic><topic>Atrial fibrillation</topic><topic>Chronic kidney disease</topic><topic>Ischemic stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, David Ray</creatorcontrib><creatorcontrib>Chiang, Hsiu-Yin</creatorcontrib><creatorcontrib>Hsiao, Ya-Luan</creatorcontrib><creatorcontrib>Le, Uyen-Minh</creatorcontrib><creatorcontrib>Hong, Yu-Cuyan</creatorcontrib><creatorcontrib>Chang, Shih-Sheng</creatorcontrib><creatorcontrib>Chen, Ke-Wei</creatorcontrib><creatorcontrib>Lin, Che-Chen</creatorcontrib><creatorcontrib>Yeh, Hung-Chieh</creatorcontrib><creatorcontrib>Ting, I-Wen</creatorcontrib><creatorcontrib>Chen, Pei-Chun</creatorcontrib><creatorcontrib>Chen, Hung-Lin</creatorcontrib><creatorcontrib>Chang, Kuan-Cheng</creatorcontrib><creatorcontrib>Kuo, Chin-Chi</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Atherosclerosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, David Ray</au><au>Chiang, Hsiu-Yin</au><au>Hsiao, Ya-Luan</au><au>Le, Uyen-Minh</au><au>Hong, Yu-Cuyan</au><au>Chang, Shih-Sheng</au><au>Chen, Ke-Wei</au><au>Lin, Che-Chen</au><au>Yeh, Hung-Chieh</au><au>Ting, I-Wen</au><au>Chen, Pei-Chun</au><au>Chen, Hung-Lin</au><au>Chang, Kuan-Cheng</au><au>Kuo, Chin-Chi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients</atitle><jtitle>Atherosclerosis</jtitle><addtitle>Atherosclerosis</addtitle><date>2025-02-01</date><risdate>2025</risdate><volume>401</volume><spage>119055</spage><pages>119055-</pages><artnum>119055</artnum><issn>0021-9150</issn><issn>1879-1484</issn><eissn>1879-1484</eissn><abstract>The interaction between full-spectrum chronic kidney disease (CKD) and atrial fibrillation (AF) on ischemic stroke and all-cause mortality risk, particularly in stage 4 and 5 CKD, remains undetermined.
This matched cohort study identified incident AF patients using the International Classification of Disease codes and electrocardiograms from the Clinical Research Data Repository of China Medical University Hospital between 2003 and 2020. For each AF patient, we selected four controls without AF and matched them by age, sex, eGFR within 10 mL/min/1.73 m2, end-stage kidney disease (ESKD) vintage, and diagnosis year. Multivariable Cox proportional hazard models were utilized to assess the interaction between AF and CKD on three-year ischemic stroke and all-cause mortality outcomes.
Within a total of 10,155 patients and 39,439 controls, incidence rates were 3.03 % and 1.48 % for ischemic stroke and 15.6 % and 9.53 % for overall mortality, respectively. In AF, the stroke risk was the highest among patients with stage 4 and 5-ND (non-dialysis) CKD with adjusted hazard ratio (aHR) of 3.31 (95 % CI, 2.46–4.45) and 2.73 (1.88–3.96), respectively. The mortality risk difference varied between 45% and 177 % with the highest difference noted in ESKD (aHR 3.36 [95 % CI, 2.84–3.98] in AF vs. 1.59 [95 % CI, 1.28–1.96] in non-AF; interaction p < 0.001). Anticoagulation therapy significantly lowered the mortality risk among patients with AF and advanced CKD (3-way interaction p < 0.001).
The risk of ischemic stroke and overall mortality was particularly high among patients with concurrent AF and stage 4 and 5-ND CKD, underscoring the urgent evidence to optimize prognosis.
[Display omitted]
•The highest risk of ischemic stroke and bleeding is observed in AF patients with stage 4 and 5 CKD, respectively.•AF and CKD mutually escalate the risk of all-cause mortality, reaching a peak in ESKD patients.•Anticoagulation use modifies the association pattern between AF and CKD, offsetting the risk of AF on all-cause mortality.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>39647253</pmid><doi>10.1016/j.atherosclerosis.2024.119055</doi><orcidid>https://orcid.org/0000-0002-2050-1377</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | All-cause mortality Atrial fibrillation Chronic kidney disease Ischemic stroke |
| title | Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients |
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