Estimated glomerular filtration ratio is a better index than creatinine clearance (Cockcroft-Gault) for predicting the prevalence of atrial fibrillation in the general Japanese population

Direct oral anti-coagulants (DOACs) have been used in patients with non-valvular atrial fibrillation (AF), and renal function evaluation using the CCr (Cockcroft-Gault) is recommended as a criterion for the reduction of DOAC. In contrast, estimated glomerular filtration rate (eGFR) is usually used as an index of renal function in daily practice. We determined the age- and gender-specific prevalence rates of AF and whether CCr or eGFR was associated with the prevalence of AF. Data from the periodic health examinations of 108,951 subjects were collected. Risk factors for AF were determined based on medical history, physical examinations and blood samples, and AF was diagnosed based on electrocardiography. The prevalence rate of AF was 0.92% (998/108,951). It was four times higher in men than in women and increased with age. Cardiac disease (odds ratio (OR) = 27.07, confidence interval (CI) 23.39-31.37, p = 0.0001), male gender (OR = 3.65, CI 3.11-4.30), age > 65 years (OR = 2.52, CI 2.14-2.96), hyperlipidemia (OR = 2.51, CI 1.97-3.20), BMI > 25 kg/m(2) (OR = 1.37, CI 1.19-1.58) and hypertension (OR= 1.14, CI 1.11-1.16) were independently associated with a high risk of AF in the multivariate logistic regression analysis. The odds ratio of having AF was significantly higher in patients with eGFR <= 59 (OR = 2.10, CI 1.21-3.86) than in those with eGFR >= 90 but was not associated with CCr after adjustments for age, gender, diabetes mellitus and smoking. The significance of this difference disappeared after additional adjustment for hypertension. Cardiac disease, gender, age, hyperlipidemia, obesity, hypertension and renal dysfunction were strong risk factors for AF. The evaluation of renal dysfunction as a morbidity risk factor for AF suggests that eGFR should be used.