Chronic kidney disease (CKD) in patients with newly diagnosed atrial fibrillation (AF) is significantly associated with a lower likelihood of receiving treatment for AF, and the likelihood decreases with increasing CKD severity, according to investigators.

In a study that included 115,564 patients with newly diagnosed AF receiving care in 2 large integrated health care delivery systems, those with an estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) of 30-44, 15-29, and less than 15 had a significant 9%, 22%, and 36% decreased likelihood of receiving any AF therapy, respectively, in adjusted analyses compared with those who had an eGFR greater than 60, Nisha Bansal, MD, of the Kidney Research Institute at the University of Washington in Seattle, and colleagues reported in the Journal of the American Society of Nephrology. The investigators defined CKD as an eGFR less than 60.

Compared with patients who had an eGFR greater than 60, those with an eGFR of 45-59, 30-44, 15-29, and less than 15 had a significant 10%, 22%, 39%, and 59% decreased likelihood of treatment with rate control agents (such as beta blockers, calcium channel blockers, digoxin), respectively, and 13%, 45%, 77%, and 95% decreased likelihood of receiving direct oral anticoagulants in fully adjusted models. Patients with an eGFR of 15-29 and less than 15 had a significant 11% and 19% decreased likelihood of receiving warfarin.

“These data highlight opportunities to re-evaluate the level of evidence supporting the use of these therapies across the spectrum of CKD severity and to potentially improve management of AF in the CKD population with the goal of improved long-term cardiovascular and kidney outcomes,” Dr Bansal and colleagues wrote.


Bansal N, Zelnick L, Reynolds K, et al. Management of adults with newly diagnosed atrial fibrillation with and without chronic kidney disease. J Am Soc Nephrol. Published online December 17, 2021. doi:10.1681/ASN.2021060744