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

Francesco Violi, Daniele Pastori, Francesco Perticone, William R Hiatt, Angela Sciacqua, Stefania Basili, Marco Proietti, Gino R Corazza, Gregory Y H Lip, Pasquale Pignatelli, ARAPACIS (Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study) STUDY group, Luciano Cominacini, Chiara Mozzini, Daniela De Palma, Maurizio Galderisi, Giuseppe Cudemo, Ferruccio Galletti, Valeria Fazio, Luigi Elio Adinolfi, Ausilia Sellitto, Luciano Restivo, Mauro Cacciafesta, Nicola Gueli, Pietro Castellino, Irene Curto, Claudia Vecchio, Giorgio Sesti, Franco Arturi, Alessandro Grembiale, Francesco Perticone, Paola Elisa Scarpino, Giuseppe Carullo, Gianpaolo Vidili, Sebastiana Atzori, Giuseppe Delitala, Dario Di Michele, Alessandra Fava, Marco Bertolotti, Chiara Mussi, Elisabetta De Luca, Francesca De Zaiacomo, Valter Giantin, Roberto Corazza Gino, Emanuela Miceli, Donatella Padula, Donato Santovito, Francesco Cipollone, Paola Andreozzi, Evaristo Ettorre, Giovanni Viscogliosi, Nicola Glorioso, Giada Melis, Gianfranca Marras, Michela Matta, Massimo Porta, Maria Felice Brizzi, Carlo Moroni, Lucia Valente, Francesco Lopreiato, Adelina Gentile, Vania Catozzo, Elena Rancan, Walter Ageno, Luigina Guasti, Roberto Cangemi, Francesca Serena Pignataro, Daniele Pastori, Domenico Ferro, Lorenzo Loffredo, Ludovica Perri, Elisa Catasca, Valeria Raparelli, Laura Napoleone, Bucci Tommaso, Baratta Francesco, Giovanni Talerico, Camilla Calvieri, Tommasa Vicario, Roberta Russo, Mirella Saliola, Maria Del Ben, Francesco Angelico, Anna Rita Vestri, Alessio Farcomeni, Gianluca Di Tanna, Giovanni Davi, Stefania Basili, Pier Mannuccio Mannucci, Francesco Perticone, Gregory Y H Lip, William Hiatt, Anna Rita Vestri, Gino Roberto Corazza, Giuseppe Licata, Francesco Violi, Paolo Gobbi, Stefania Basili, Salvatore Corrao, Francesco Violi, Daniele Pastori, Francesco Perticone, William R Hiatt, Angela Sciacqua, Stefania Basili, Marco Proietti, Gino R Corazza, Gregory Y H Lip, Pasquale Pignatelli, ARAPACIS (Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study) STUDY group, Luciano Cominacini, Chiara Mozzini, Daniela De Palma, Maurizio Galderisi, Giuseppe Cudemo, Ferruccio Galletti, Valeria Fazio, Luigi Elio Adinolfi, Ausilia Sellitto, Luciano Restivo, Mauro Cacciafesta, Nicola Gueli, Pietro Castellino, Irene Curto, Claudia Vecchio, Giorgio Sesti, Franco Arturi, Alessandro Grembiale, Francesco Perticone, Paola Elisa Scarpino, Giuseppe Carullo, Gianpaolo Vidili, Sebastiana Atzori, Giuseppe Delitala, Dario Di Michele, Alessandra Fava, Marco Bertolotti, Chiara Mussi, Elisabetta De Luca, Francesca De Zaiacomo, Valter Giantin, Roberto Corazza Gino, Emanuela Miceli, Donatella Padula, Donato Santovito, Francesco Cipollone, Paola Andreozzi, Evaristo Ettorre, Giovanni Viscogliosi, Nicola Glorioso, Giada Melis, Gianfranca Marras, Michela Matta, Massimo Porta, Maria Felice Brizzi, Carlo Moroni, Lucia Valente, Francesco Lopreiato, Adelina Gentile, Vania Catozzo, Elena Rancan, Walter Ageno, Luigina Guasti, Roberto Cangemi, Francesca Serena Pignataro, Daniele Pastori, Domenico Ferro, Lorenzo Loffredo, Ludovica Perri, Elisa Catasca, Valeria Raparelli, Laura Napoleone, Bucci Tommaso, Baratta Francesco, Giovanni Talerico, Camilla Calvieri, Tommasa Vicario, Roberta Russo, Mirella Saliola, Maria Del Ben, Francesco Angelico, Anna Rita Vestri, Alessio Farcomeni, Gianluca Di Tanna, Giovanni Davi, Stefania Basili, Pier Mannuccio Mannucci, Francesco Perticone, Gregory Y H Lip, William Hiatt, Anna Rita Vestri, Gino Roberto Corazza, Giuseppe Licata, Francesco Violi, Paolo Gobbi, Stefania Basili, Salvatore Corrao

Abstract

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(2)/year, and incident eGFR<60 mL/min/1.73 m(2) 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(2), and 28.7% patients had an eGFR<60 mL/min/1.73 m(2). Annual decline of eGFR was -2.0 (IQR -7.4/-0.4) mL/min/1.73 m(2)/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(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (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(2). ABI measurement may help identify patients with AF at risk of renal function deterioration.

Trial registration number: NCT01161251.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
(A) Distribution of classes of estimated glomerular filtration rate (eGFR) in the whole cohort of patients with atrial fibrillation (AF) at baseline and during follow-up. (B) Prevalence of Ankle-Brachial Index (ABI) >0.90 (Row: 0) ABI ≤0.90 (Row: 1) in patients with eGFR ≥60 mL/min/1.73 m2 (Red columns) or <60 mL/min/1.73 m2 (Blue columns).

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