Background

Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Impaired renal function (IRF) increases the risk of stroke as well, but this finding is not consistent among all studies. Our aim was to assess the incidence rates and risk of ischemic stroke and mortality by baseline Estimated Glomerular Filtration Rate (eGFR) levels Among individuals with AF and DM.

Methods

A prospective, historical cohort study using the Clalit Health Services electronic medical records database. Among patients with AF and DM, we compared three groups according to eGFR levels: eGFR ≥ 60, between 30 and 60, and ≤ 30 (mL/min/1.73m²).

Results

A total of 17,567 cases were included in the final analysis; of them, 11,013 (62.7%) had eGFR ≥ 60, 4930 (28%) had eGFR between 30 and 60, and 1624 (9.24%) with eGFR ≤ 30. The incidence of stroke per 100 person-years in the three study groups was: 1.88, 2.69, and 3.34, respectively (p < 0.001). IRF was associated with increased risk of stroke in univariate analysis, but not after multivariate adjustment (Adjusted Hazard Ratio (AHR) 0.96 {95%CI; 0.74–1.25} for eGFR 30–60 and 0.96 {95%CI; 0.60–1.55} for eGFR ≤ 30). Mortality per 100 person-years was 10.78, 21.49, and 41.55, respectively (p < 0.001). IRF was associated with increased mortality risk in univariate analysis, as well as in multivariate analysis (AHR 1.08 {95%CI; 0.98–1.18} for eGFR 30–60, and 1.59 {95%CI; 1.37–1.85} for eGFR ≤ 30.

Conclusion

In patients with NVAF and DM, IRF was not associated with an increased risk of stroke, but severe IRF (eGFR ≤ 30) was associated with increased mortality risk.

中文翻译：

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糖尿病和心房颤动患者的估计肾小球滤过率和中风风险来自一项大型当代人群研究

背景

糖尿病 (DM) 与非瓣膜性心房颤动 (NVAF) 栓塞并发症的风险增加相关。肾功能受损（IRF）也会增加中风的风险，但这一发现在所有研究中并不一致。我们的目的是通过 AF 和 DM 患者的基线估计肾小球滤过率 (eGFR) 水平来评估缺血性中风和死亡率的发病率和风险。

方法

使用 Clalit 健康服务电子病历数据库进行的一项前瞻性历史队列研究。在AF和DM患者中，我们根据eGFR水平比较了三组：eGFR≥60、30至60之间以及≤30（mL/min/1.73m ²）。

结果

共纳入17567例；其中，11,013 人（62.7%）的 eGFR ≥ 60，4930 人（28%）的 eGFR 在 30 至 60 之间，1624 人（9.24%）的 eGFR ≤ 30。 三个研究组中每 100 人年的卒中发生率分别为：1.88、2.69 和 3.34 (p < 0.001)。在单变量分析中，IRF 与中风风险增加相关，但在多变量调整后则不然（eGFR 30-60 的调整风险比 (AHR) 0.96 {95%CI; 0.74-1.25} 和 0.96 {95%CI; 0.60-1.55}） eGFR ≤ 30）。每 100 人年死亡率分别为 10.78、21.49 和 41.55 (p < 0.001)。在单变量分析和多变量分析中，IRF 与死亡风险增加相关（eGFR 30-60 的 AHR 为 1.08 {95%CI；0.98-1.18}，eGFR ≤ 30 的 AHR 为 1.59 {95%CI；1.37-1.85} 。

结论

在 NVAF 和 DM 患者中，IRF 与卒中风险增加无关，但严重 IRF（eGFR ≤ 30）与死亡风险增加相关。