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Characterization of baseline clinical factors associated with incident worsening kidney function in patients with non-valvular atrial fibrillation: the Hokuriku-Plus AF Registry

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A Correction to this article was published on 12 December 2022

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Abstract

Evidence suggests that atrial fibrillation (AF) could increase the risk of worsening kidney function (WKF) which is linked to an increased risk of stroke, bleeding, and death in AF patients. However, limited data exist regarding the factors that could lead to WKF in these patients. Therefore, we sought to identify the potential factors associated with the development of WKF in patients with non-valvular AF (NVAF). We analyzed prospectively recruited 1122 NVAF patients [men 71.9%, median age 73.0 years (interquartile range: 66.0–79.0)] with a baseline estimated glomerular filtration rate (eGFR) ≥ 15 mL/min/1.73 m2 from the Hokuriku-Plus AF Registry. The primary outcome was incident WKF, defined as the %eGFR change from the baseline ≥ 30% during the follow-up period. We evaluated the association between baseline variables and incident WKF using univariate and multivariate Cox proportional hazard models. We also evaluated the non-linear association between the identified factors and incident WKF. During a median follow-up period of 3.0 years (interquartile range: 2.7–3.3), incident WKF was observed in 108 patients (32.6 per 1000 person-years). Compared to the patients without incident WKF, the patients with incident WKF were older and had a higher prevalence of heart failure (HF), diabetes mellitus (DM), and vascular disease at baseline. Those who experienced incident WKF also had higher diastolic blood pressure, lower hemoglobin, lower eGFR, higher B-type natriuretic peptide (BNP) and used warfarin more frequently. Upon multivariate analysis, age ≥ 75 years, HF, DM, and anemia were independently associated with incident WKF. Additionally, age and hemoglobin were linearly associated with the risk of incident WKF, whereas a J- or U-shaped association was observed for HbA1c and BNP. Age ≥ 75 years, HF, DM, and anemia were associated with the development of WKF in Japanese patients with NVAF. In patients with these risk factors, a careful monitoring of the kidney function and appropriate interventions may be important when possible.

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Acknowledgements

We sincerely appreciate the help of all the participating institutions and physicians which are listed in supplementary data.

The following is a list of the institutions participating in the Hokuriku-Plus AF Registry. Kanazawa University Hospital (Yamagishi M, Fujino N, Nohara A, Kawashiri MA, Hayashi K, Sakata K, Yoshimuta T, Konno T, Funada A, Tada H, Nakanishi C, Hodatsu A, Mori M, Tsuda T, Teramoto R, Nagata Y, Nomura A, Shimojima M, Yoshida S, Yoshida T, Hachiya S, Mori M, Tamura Y, Kashihara Y, Kobayashi T, Shibayama J, Inaba S); Ishikawa Prefectural Central Hospital (Matsubara T, Yasuda T, Miwa K, Inoue M, Fujita T, Yakuta Y, Aburao T, Matsui T, Higashi K, Koga T, Hikishima K); Kanazawa Cardiovascular Hospital (Namura M, Horita Y, Ikeda M, Terai H, Gamou T, Tama N, Kimura R, Tsujimoto D, Nakahashi T); Komatsu Municipal Hospital (Ueda K, Ino H, Higashikata T, Kaneda T, Takata M, Yamamoto R, Yoshikawa T, Ohira M, Suematsu T);Kaga Medical Center (Tagawa S, Inoue T, Okada H); Wajima Municipal Hospital (Kita Y); Suzu General Hospital (Fujita C, Ukawa N, Inoguchi Y); KKR Hokuriku Hospital (Ito Y); Saiseikai Kanazawa Hospital (Araki T, Oe K); JCHO Kanazawa Hospital(Minamoto M, Yokawa J, Tanaka Y); Houju Memorial Hospital(Mori K), Toyama Red Cross Hospital (Taguchi T, Kaku B, Katsuda S); Takaoka City Hospital (Hirase H, Haraki T, Fujioka K, Terada K, Ichise T, Maekawa N, Higashi M); Kouseiren Takaoka Hospital (Okeie K, Kiyama M, Ota M); Hokuriku Central Hospital (Todo Y); Fukui Prefectural Hospital (Aoyama T, Yamaguchi M, Noji Y, Mabuchi T, Yagi M, Niwa S, Takashima Y, Murai K, Nishikawa T); Fukui Cardiovascular Center (Mizuno S, Ohsato K, Misawa K, Kokado H); Yokohama Sakae Kyosai Hospital (Michishita I, Iwaki T, Nozue T, Katoh H, Nakashima K, Ito S); Ishikawa Health Service Association Clinic (Yamagishi M).

Funding

The Hokuriku-Plus AF Registry was partially supported by the Japan Agency for Medical Research and Development (AMED) under Grant Number JP17ek0210082 (K.H.), and Grant-in-Aid for Early-Career Scientists under Grant Number 21K16052 (T.T.).

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  1. Kenshi Hayashi and Yoshihiro Tanaka contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Kenshi Hayashi, Yoshihiro Tanaka, Toyonobu Tsuda, Akihiro Nomura, Noboru Fujino, Hiroshi Furusho, Soichiro Usui, Kenji Sakata, Takeshi Kato, Hayato Tada, Takashi Kusayama, Keisuke Usuda, Masa-aki Kawashiri, Masakazu Yamagishi & Masayuki Takamura

  2. Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Yoshihiro Tanaka & Rod S. Passman

  3. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Yoshihiro Tanaka

  4. Department of Cardiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsuki-higashi, Kanazawa, Japan

    Hiroshi Furusho

  5. Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Japan

    Norihiko Sakai, Yasunori Iwata & Takashi Wada

  6. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Rod S. Passman

  7. Osaka University of Human Sciences, Settsu, Osaka, Japan

    Masakazu Yamagishi

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Consortia

the Hokuriku-Plus AF Registry Investigators

  • M Yamagishi
  • , N Fujino
  • , A Nohara
  • , MA Kawashiri
  • , K Hayashi
  • , K Sakata
  • , T Yoshimuta
  • , T Konno
  • , A Funada
  • , H Tada
  • , C Nakanishi
  • , A Hodatsu
  • , M Mori
  • , T Tsuda
  • , R Teramoto
  • , Y Nagata
  • , A Nomura
  • , M Shimojima
  • , S Yoshida
  • , T Yoshida
  • , S Hachiya
  • , Y Tamura
  • , Y Kashihara
  • , T Kobayashi
  • , J Shibayama
  • , S Inaba
  • , T Matsubara
  • , T Yasuda
  • , K Miwa
  • , M Inoue
  • , T Fujita
  • , Y Yakuta
  • , T Aburao
  • , T Matsui
  • , K Higashi
  • , T Koga
  • , K Hikishima
  • , M Namura
  • , Y Horita
  • , M Ikeda
  • , H Terai
  • , T Gamou
  • , N Tama
  • , R Kimura
  • , D Tsujimoto
  • , T Nakahashi
  • , K Ueda
  • , H Ino
  • , T Higashikata
  • , T Kaneda
  • , M Takata
  • , R Yamamoto
  • , T Yoshikawa
  • , M Ohira
  • , T Suematsu
  • , S Tagawa
  • , T Inoue
  • , H Okada
  • , Y Kita
  • , C Fujita
  • , N Ukawa
  • , Y Inoguchi
  • , Y Ito
  • , T Araki
  • , K Oe
  • , M Minamoto
  • , J Yokawa
  • , Y Tanaka
  • , K Mori
  • , T Taguchi
  • , B Kaku
  • , S Katsuda
  • , H Hirase
  • , T Haraki
  • , K Fujioka
  • , K Terada
  • , T Ichise
  • , N Maekawa
  • , M Higashi
  • , K Okeie
  • , M Kiyama
  • , M Ota
  • , Y Todo
  • , T Aoyama
  • , M Yamaguchi
  • , Y Noji
  • , T Mabuchi
  • , M Yagi
  • , S Niwa
  • , Y Takashima
  • , K Murai
  • , T Nishikawa
  • , S Mizuno
  • , K Ohsato
  • , K Misawa
  • , H Kokado
  • , I Michishita
  • , T Iwaki
  • , T Nozue
  • , H Katoh
  • , K Nakashima
  • , S Ito
  •  & M Yamagishi

Corresponding author

Correspondence to Kenshi Hayashi.

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Conflict of interest

R.S.P. received grants from Abbott, royalties from UpToDate, consulting fees from Medtronic and Janssen, payment or honoraria from Medtronic, and payment for expert testimony from Teva. K.H. received lecture fees from Bayer Healthcare and Daiichi Sankyo. T.T. received lecture fees from Bristol-Myers Squibb. All other authors have declared no conflict of interest.

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Hayashi, K., Tanaka, Y., Tsuda, T. et al. Characterization of baseline clinical factors associated with incident worsening kidney function in patients with non-valvular atrial fibrillation: the Hokuriku-Plus AF Registry. Heart Vessels 38, 402–411 (2023). https://doi.org/10.1007/s00380-022-02178-w

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