Association of estimated glomerular filtration rate differences with brain lesions in patients with atrial fibrillation
M Mutti, P Krisai, S Aeschbacher, M Coslovsky, R E Paladini, T Reichlin, N Rodondi, P Ammann, G Moschovitis, G Conte, S Osswald, D Conen, F Mahfoud, M KuehneAbstract
Background
Kidney function overestimation by creatinine compared to cystatin C has been associated with adverse clinical outcomes.
Aim
To investigate the prevalence of discrepancies between creatinine-based and cystatin C-based glomerular filtration rate estimations (eGFRdiff) and its associations with MRI-detected brain lesions in patients with atrial fibrillation (AF).
Methods
We analyzed 1,722 patients with AF enrolled in the prospective, multicenter Swiss-AF study. For each patient, the presence of large noncortical or cortical infarcts (LNCCI), small noncortical infarcts (SNCI), and moderate-to-severe white matter hyperintensities (WMH) (Fazekas score ≥2) was assessed on brain MRI. eGFRdiff was calculated as the 2021 CKD-EPI creatinine-cystatin C equation minus the creatinine-only equation and categorized into quartiles.
Results
Mean age was 73 years, 27% were female, and 46% had paroxysmal AF. The median eGFRdiff was -0.49 ml/min/1.73 m² (IQR -5.94, 5.67). Prevalent MRI-detected brain infarcts (44.2%, 45.1%, 34.0%, 28.1%; p < 0.001) and moderate-to-severe white matter hyperintensities (63.0%, 60.1%, 51.8%, 39.1%; p < 0.001) were more frequent among patients in quartiles 1 and 2 compared to patients in quartiles 3 and 4. In multivariable adjusted restricted cubic spline models (p for nonlinearity = 0.026), the odds of prevalent LNCCI and/or SNCI were higher at mildly to moderately negative and lower at mildly to moderately positive eGFRdiff values (Figure). A similar trend was seen in multivariable-adjusted linear models, where an increase of 1 ml/min/1.73 m² eGFRdiff was associated with 1.4% lower odds of moderate-to-severe white matter hyperintensities (OR 0.986, 95% CI 0.974–0.998, p = 0.027).
Conclusion
Discrepancies between creatinine- and cystatin C-based eGFR are common among patients with AF. An eGFR overestimation by creatinine relative to cystatin C was associated with a greater burden of ischemic brain lesions and WMH. A negative eGFRdiff may indicate systemic or vascular processes associated with brain lesions.Graphical Abstract