Improvement in renal and endothelial function after catheter ablation in patients with persistent atrial fibrillation
JOURNAL OF CARDIOLOGY
Authors: Okawa, Keisuke; Miyoshi, Toru; Sogo, Masahiro; Hara, Shohei; Sudo, Yuya; Ugawa, Satoko; Takahashi, Masahiko; Doi, Masayuki; Morita, Hiroshi; Ito, Hiroshi
Abstract
Background: Cardiovascular events in patients with atrial fibrillation (AF) can be lowered by catheter ablation. We hypothesized the underlying mechanism was improvement in renal and endothelial function corresponding to AF burden, and investigated whether restoration of sinus rhythm (SR) after ablation affected these functions according to AF type. Methods and Results: We prospectively measured estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and reactive hyperemia index (RHI) in 358 consecutive patients with AF before and 6 and 12 months after the ablation. For each AF type [paroxysmal AF (PAF), n = 229, and persistent AF (PeAF), n = 129], we evaluated changes in these markers and influence of chronic kidney disease (CKD). The eGFR and natural logarithm-transformed (In) UACR improved at 6 months in the PeAF group (68.7 +/- 18.7-71.8 +/- 18.9 mL/min/1.73 m(2), p = 0.003 and 3.1 +/- 1.6 to 2.8+1.5, p < 0.001, respectively) and remained unchanged in the PAF group. Among the PeAF patients, recurrent AF was identified in 41, but only transiently in 38 patients. PeAF at baseline independently predicted increased eGFR [odds ratio (OR)=2.13, 95 % confidence interval (CI) 1.35-3.40, p = 0.001] and decreased UACR (OR=1.94, 95 % CI 1.05-3.58, p = 0.033). In the PeAF patients with CKD, In-RHI significantly increased at 6 months after the ablation, and the change (Delta) in In-RHI was significantly correlated with the Delta eGFR (r=0.35, p = 0.03). Conclusions: SR restoration after ablation was associated with an improved eGFR and UACR in PeAF patients, but not PAF patients. In PeAF patients with CKD, an improved endothelial function after ablation was associated with an improved renal function. (C) 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Integration of biomonitoring data and reverse dosimetry modeling to assess population risks of arsenic-induced chronic kidney disease and urinary cancer
ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY
Authors: Lin, Yi-Jun; Hsiao, Ju-Ling; Hsu, Hui-Tsung
Abstract
Chronic exposure to inorganic arsenic (iAs) is associated with chronic kidney disease (CKD) and urinary cancer, but the risks are poorly understood. Human biomonitoring can serve as a tool to better quantify human exposure and to conduct risk assessment. We aimed to assess the population risks of CKD and urinary cancer due to iAs intake based on the blood arsenic concentrations of 601 participants in Taiwan. A physiologically based pharmacokinetic modeling-based reverse dosimetry was conducted to estimate the daily intakes of iAs (Db(iAs)). We performed the benchmark dose (BMD) modeling for CKD using participants' estimated glomerular filtration rate (eGFR) and the estimated DIiAs to derive a point of departure (POD). Margin of exposure (MOE) was used to characterize the risks. The population with eGFR values of <60 mL/min/1.73 m(2) had significantly higher DL A , (median: 3.20 mu g/kg/day, 2.5th-97.5th percentiles: 2.35-4.67 mu g/kg/day) than those with normal renal function (1.99, 1.22-3.42 mu g/kg/day). The POD for CKD was 1.557 mu g/kg/day, which could serve as a possible reference value for CKD risk assessment. The MOEs indicated that the CKD risk due to iAs intake may potentially be a cause for high concern for the population with reduced renal function. The iAs-induced urinary cancer risk may be a cause for moderate-to-high concern.
COA
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