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Purpose: Chronic kidney disease with renal dysfunction (RD) is associated with an increased risk of thromboembo- lic and hemorrhagic events in non-valvular atrial fibrillation (NVAF). Although the current European Guidelines on NVAF suggest that an accurate evaluation of the renal func- tion is useful in hemorrhagic risk stratification, it has not been yet considered in thromboembolic risk score CHA 2- DS2VASc. The aim of our study was to evaluate the prog- nostic role of RD in a wide "real world" population of NVAF outpatients. 2DS2VASc score was 4 (range 3-5) and ≥2 points in 91.1% of patients. During a median follow-up of 27 months, 531 (35%) deaths or CVH, 113 (7.5%) thromboem- bolic events and 24 (1.6%) major bleedings were recorded. The presence of RD identified a group of older patients with more cardiovascular (CV) risk factors, more severe heart disease, higher Charlson Index, more concomitant medical therapies. During the follow-up, we recorded 48% vs 30% of deaths or CVH (p<0.001), 10% vs 7% of thromboembolic events (p=0.02) and 2.5% vs 1% of hemorrhagic events in those with and without RD (p=0.09). Patients with RD sho- wed a global worse prognosis for CVH/death-free survival independently from the prescription of anticoagulant (p<0.001). Instead, considering thromboembolism/major bleeding free survival, patients with RD had a worse prog- nosis only if taking anticoagulants (p=0.038). We can hypo- thesize that it could be probably related to a relatively high- er number of thromboembolic events in the past medical history in the anticoagulant group versus antiplatelets or not therapy (11,4% vs 9,5% vs 5,1%, respectively, p<0.001). Conclusions: In a "real world" of NVAF outpatients, RD identified a subgroup of older patients, with more complex CV and non CV disease at higher risk of CV, thromboem- bolic and hemorrhagic events. RD was associated with a higher rate of thromboembolism/major bleeding in patients on anticoagulants.

Is it time to calculate renal function in non valvular atrial fibrillation patients to stratify the risk of future events?