The CHA 2 DS 2 -VASc score strongly correlates with glomerular filtration rate and predicts renal function decline over time in elderly patients with atrial fibrillation and chronic kidney disease.

BACKGROUND: The decline of renal function affects stroke risk in patients with atrial fibrillation (AF). Here, we aim to study the predictive value of the CHA2 DS2 -VASc score, a stroke-risk stratification model in AF, for renal function and renal decline in patients with AF and chronic kidney disease (CKD).

METHODS: Two electronic health record cohorts with AF and CKD stage III/IV were evaluated (Cohort #1 (IMS-DA, Germany): 18,539 patients with 125,149 estimated glomerular filtration rate (eGFR) measurements; Cohort #2 (IMS-THIN, United Kingdom): 18,240 patients with 133,676 eGFR measurements). The eGFR trajectories were analysed with multi-level mixed-effects regression and joint models for longitudinal and survival data.

RESULTS: In IMS-DA, the mean baseline eGFR was 52.0ml/min/1.73m2 , and declined by 1.03ml/min/1.73m2 /year (95%CI: 0.86-1.19, p<0.0001). In IMS-THIN, the mean baseline eGFR was 48.0ml/min/1.73m2 , and declined by 0.44ml/min/1.73m2 /year (95%CI: 0.37-0.51, p<0.0001). In both datasets, higher CHA2 DS2 -VASc scores (median: 4 points) were strongly associated with both lower baseline eGFR (p<0.0001) and faster progression of CKD (p=0.002). Mean baseline eGFR values were higher in patients with a CHA2 DS2 -VASc score of 0 compared to patients with a score of 8 points. Conversely, the annual declines in eGFR were lower in patients with a score of 0 compared to patients with a score of 8 points in both databases.

CONCLUSION: The CHA2 DS2 -VASc score can identify AF patient subgroups with lower baseline eGFR and a higher risk of CKD progression, which has important implications for the management of anticoagulation in these patients.