Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: A prospective multicentre cohort study

Salvatore Corrao, Gregory Y. H. Lip, Gino R. Corazza, Francesco Violi, Daniele Pastori, William R. Hiatt, Marco Proietti, Pasquale Pignatelli, Gregory Y. H. Lip, Daniele Pastori, Daniele Pastori, Pasquale Pignatelli, Gregory Y. H. Lip, Pasquale Pignatelli, Stefania Basili, Francesco Perticone, Angela Sciacqua

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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<sup>2</sup> /year, and incident eGFR<60 mL/min/1.73 m<sup>2</sup> 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<sup>2</sup>, and 28.7% patients had an eGFR<60 mL/min/1.73 m<sup>2</sup>. Annual decline of eGFR was -2.0 (IQR -7.4/-0.4) mL/min/1.73 m<sup>2</sup>/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<sup>2</sup>, 153 (23.9%) had a reduction of the eGFR <60 mL/min/ 1.73 m<sup>2</sup>. ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m<sup>2</sup> (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<sup>2</sup>. ABI measurement may help identify patients with AF at risk of renal function deterioration. Trial registration number: NCT01161251.
Original languageEnglish
Pages (from-to)e008026-e008026
Number of pages1
JournalBMJ Open
Publication statusPublished - 2015

All Science Journal Classification (ASJC) codes

  • General Medicine


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