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      Glomerular Filtration Rate as a Predictor of Outcome in Acute Coronary Syndrome Complicated by Atrial Fibrillation

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          Abstract

          The close relationship between kidney and heart is well known. Cardiovascular impairment contributes to the worsening of renal function and kidney failure worsens cardiovascular health. Atrial fibrillation (AF) is a frequent issue in patients with Chronic Kidney Disease (CKD) and several studies have demonstrated that AF impacts negatively on their quality of life and outcomes. Understanding the mechanisms leading to the progression of CKD, new-onset AF and acute myocardial infarction (AMI) is a key issue. The evaluation of Glomerular Filtration Rate (GFR) could make the difference in this equilibrium and suggests specific strategies in the treatment of the population at major risk of cardiovascular events. This intriguing connection paves the way for necessary further investigations.

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          The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease.

          Hiroyuki Kobori, Masaomi Nangaku, L. Gabriel Navar … (2007)
          In recent years, the focus of interest on the role of the renin-angiotensin system (RAS) in the pathophysiology of hypertension and organ injury has changed to a major emphasis on the role of the local RAS in specific tissues. In the kidney, all of the RAS components are present and intrarenal angiotensin II (Ang II) is formed by independent multiple mechanisms. Proximal tubular angiotensinogen, collecting duct renin, and tubular angiotensin II type 1 (AT1) receptors are positively augmented by intrarenal Ang II. In addition to the classic RAS pathways, prorenin receptors and chymase are also involved in local Ang II formation in the kidney. Moreover, circulating Ang II is actively internalized into proximal tubular cells by AT1 receptor-dependent mechanisms. Consequently, Ang II is compartmentalized in the renal interstitial fluid and the proximal tubular compartments with much higher concentrations than those existing in the circulation. Recent evidence has also revealed that inappropriate activation of the intrarenal RAS is an important contributor to the pathogenesis of hypertension and renal injury. Thus, it is necessary to understand the mechanisms responsible for independent regulation of the intrarenal RAS. In this review, we will briefly summarize our current understanding of independent regulation of the intrarenal RAS and discuss how inappropriate activation of this system contributes to the development and maintenance of hypertension and renal injury. We will also discuss the impact of antihypertensive agents in preventing the progressive increases in the intrarenal RAS during the development of hypertension and renal injury.
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            Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.

            Ayodele Odutayo, Christopher X Wong, Allan Hsiao … (2016)
            To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death.
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              Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy.

              Volker Wizemann, Lin Tong, Sudtida Satayathum … (2010)
              Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we determined incidence, prevalence, and outcomes among hemodialysis patients with atrial fibrillation. Cox proportional hazards models, to identify associations with newly diagnosed atrial fibrillation and clinical outcomes, were stratified by country and study phase and adjusted for descriptive characteristics and comorbidities. Of 17,513 randomly sampled patients, 2188 had preexisting atrial fibrillation, with wide variation in prevalence across countries. Advanced age, non-black race, higher facility mean dialysate calcium, prosthetic heart valves, and valvular heart disease were associated with higher risk of new atrial fibrillation. Atrial fibrillation at study enrollment was positively associated with all-cause mortality and stroke. The CHADS2 score identified approximately equal-size groups of hemodialysis patients with atrial fibrillation with low (less than 2) and higher risk (more than 4) for subsequent strokes on a per 100 patient-year basis. Among patients with atrial fibrillation, warfarin use was associated with a significantly higher stroke risk, particularly in those over 75 years of age. Our study shows that atrial fibrillation is common and associated with elevated risk of adverse clinical outcomes, and this risk is even higher among elderly patients prescribed warfarin. The effectiveness and safety of warfarin in hemodialysis patients require additional investigation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Med
                Journal ID (iso-abbrev): J Clin Med
                Journal ID (publisher-id): jcm
                Title: Journal of Clinical Medicine
                Publisher: MDPI
                ISSN (Electronic): 2077-0383
                Publication date (Electronic): 14 May 2020
                Publication date Collection: May 2020
                Volume: 9
                Issue: 5
                Electronic Location Identifier: 1466
                Affiliations
                [1 ]Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; dsantoro@ 123456unime.it (D.S.); guidogembillo@ 123456live.it (G.G.)
                [2 ]Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
                Author notes
                [* ]Correspondence: giuseppe.ando@ 123456unime.it ; Tel.: +39-090-221-3458
                Author information
                https://orcid.org/0000-0002-4279-6559
                https://orcid.org/0000-0003-4823-9910
                https://orcid.org/0000-0001-5552-6382
                Article
                Publisher ID: jcm-09-01466
                DOI: 10.3390/jcm9051466
                PMC ID: 7290385
                PubMed ID: 32422873
                SO-VID: ea7992ea-feb1-458e-8795-2952e1401774
                Copyright © © 2020 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 10 May 2020
                Date accepted : 12 May 2020
                Categories
                Subject: Editorial

                Keywords: chronic kidney disease,glomerular filtration rate,atrial fibrillation,acute myocardial infarction,acute coronary syndrome
                Data availability:
                Keywords: chronic kidney disease, glomerular filtration rate, atrial fibrillation, acute myocardial infarction, acute coronary syndrome

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