ESC Congress 2026 Abstract · Oct 26, 2026
Association of atrial fibrillation and chronic kidney disease with brain lesions and cognition
By Gisler N, Mutti M, Aeschbacher S et al.
Background: Atrial fibrillation (AF) and chronic kidney disease (CKD) are independent risk factors for brain infarcts and cognitive decline. However, their combined impact on brain lesions remains underinvestigated. Purpose: To quantify the associations of CKD, AF and their combination with MRI-detected brain lesions and cognition. Methods: We analysed 2,712 patients enrolled in the prospective, multicenter Swiss-AF cohort with standardized brain-MRI and cognitive assessment with the MoCA test. Patients were stratified into four groups according to their AF and CKD medical history: AF-/CKD- (Reference), AF-/CKD+, AF+/CKD-, and AF+/CKD+. Investigated brain lesions were large non-cortical or cortical infarcts (LNCCI), small non-cortical infarcts (SNCI) and white matter hyperintensities (WMH) (Fazekas score ≥2). Logistic regression models were used to assess the associations between each patient group and brain lesion type. Results: Mean age was 73.1 years, 30.8% were female, 17% had CKD and 64% AF. The prevalence of each brain lesion increased across the four patient groups (Fig. Panel A). LNCCI and/or SNCI were present in 22.3% in AF-/CKD-, 32.9% in AF-/CKD+, 34.0% in AF+/CKD- and 49.5% in AF+/CKD+, with consistent results for LNCCI and SNCI individually. Similarly, WMH were present in 42.1%, 55.9%, 50.8% and to 66.9% across the respective groups. In adjusted regression models, only AF+/CKD- (OR 1.63; 95% CI 1.18-2.26; p=0.003) and AF+/CKD+ (OR 2.51; 95% CI 1.71-3.71; p<0.001), but not AF-/CKD+ were associated with LNCCI and/or SNCI (Fig. Panel C). Associations were consistent for SNCI and WMH, but not for LNCCI. MoCA-scores were highest in the reference group (26.2 ± 2.8), followed by comparable values in AF+/CKD- (25.2 ± 3.0) and AF-/CKD+ (25.1 ± 3.2), and were lowest in AF+/CKD+ (24.3 ± 3.4) (Fig. Panel B). Formal interaction testing between AF and CKD was non-significant for all outcomes (p>0.05). Conclusion: Patients with concomitant AF and CKD had the highest prevalence of micro- and macrovascular brain lesions and the lowest cognitive function. The odds for brain lesions in patients with both conditions was more than twice compared to controls and exceeded the risk of either condition alone. AF and CKD did not interact with regards to brain lesions, suggesting individual pathophysiological pathways.Association AF x CKD with Brain Lesions A/BAssociation AF x CKD with Brain Lesions C