Incident Atrial Fibrillation and Risk of End-Stage Renal Disease in Adults With Chronic Kidney Disease

1 University of California, San Francisco, San Francisco, CA
Circulation (Impact Factor: 14.43). 12/2012; 127(5). DOI: 10.1161/CIRCULATIONAHA.112.123992
Source: PubMed


Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD); however, the long‐term impact of development of AF on the risk of death among patients with CKD is unknown.

Methods and Results
We studied adults with CKD (glomerular filtration rate <60 mL/min per 1.73 m2 by the Chronic Kidney Disease Epidemiology Collaboration equation) identified between 2002 and 2010 who were enrolled in Kaiser Permanente Northern California and had no previously documented AF. Incident AF was identified using primary hospital discharge diagnoses or ≥2 outpatient visits for AF. Death was comprehensively ascertained from health plan administrative databases, Social Security Administration vital status files, and the California death certificate registry. Covariates included demographics, comorbidity, ambulatory blood pressure, laboratory values (hemoglobin, proteinuria), and longitudinal medication use. Among 81 088 adults with CKD, 6269 (7.7%) developed clinically recognized incident AF during a mean follow‐up of 4.8±2.7 years. There were 2388 cases of death that occurred after incident AF (145 per 1000 person‐years) compared with 18 865 cases of death during periods without AF (51 per 1000 person‐years, P<0.001). After adjustment for potential confounders, incident AF was associated with a 66% increase in relative rate of death (adjusted hazard ratio 1.66, 95% CI 1.57 to 1.77).

Incident AF is independently associated with an increased risk of death in adults with CKD. Further study is needed to understand the mechanisms by which CKD is associated with AF and to identify potentially modifiable risk factors to decrease the burden of AF and subsequent risk of death in this high‐risk population.

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    • "Having atrial fibrillation was another risk factor associated with AKI in acute ischemic stroke patients. Atrial fibrillation could promote systemic inflammation, induce fibrosis within the myocardium, and contribute to decline of left ventricular systolic and diastolic function over time.16 It was known that effective arterial volume could be low in patients with atrial fibrillation. "
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    ABSTRACT: Antiedema therapy with mannitol and furosemide is widely used for prevention and management of cerebral edema, elevated intracranial pressure, and cerebral hernia. There are some reports about mannitol and furosemide as risk factors of acute kidney injury (AKI). We investigated the risk factors for AKI including antiedema therapy in acute ischemic stroke patients. The subjects were 129 patients with acute ischemic stroke including 56 females and 73 males with a mean age 68.16±12.29 years. Patients were divided into two groups: patients with AKI and without AKI according to Acute Kidney Injury Network criteria. All patients had undergone cranial, carotid, and vertebral artery evaluation with magnetic resonance imaging. The number of patients with AKI was 14 (10.9%). Subjects experiencing atrial fibrillation (P=0.043) and higher diastolic blood pressure (DBP) (P=0.032) treated with mannitol (P=0.019) and furosemide (P=0.019) disclosed significant association with AKI. Regression analysis revealed that higher DBP (P=0.029) and management with mannitol (P=0.044) were the risk factors for AKI. Higher DBP at admission is the most important risk factor for AKI. However antiedema therapy should be used carefully in patients with acute ischemic stroke. Serum creatinine levels or estimated glomerular filtration rate should be watched frequently to prevent AKI.
    International Journal of Nephrology and Renovascular Disease 02/2014; 7:101-5. DOI:10.2147/IJNRD.S59443
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    ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Epidemiologic studies have reported an increased prevalence of AF with increasing age [1]. The increased prevalence of AF over the previous years was initially attributed to the expanding population of elders in the population. Subsequent epidemiologic studies reported that even on adjustment for age and other comorbidities the prevalence of AF was increasing suggesting possible influence of other underlying conditions [2-6]. Renal failure and cardiovascular diseases share many common risk factors like age, hypertension, diabetes and many more. Recently, the association of these two conditions has gained special relevance not only because of common risk factors but because of important prognostic implications associated with these conditions occurring together, especially in an elderly population [7,8]. Over the last couple of decades, an increase in prevalence of AF has been reported in hemodialysis (HD) patients [9]. The issues associated with AF in patients with chronic kidney disease (CKD) have been discussed in this section.
    Cardiovascular Risk and Renal Disease, Edited by Nicolas Roberto Robles, 01/2013: chapter Atrial Fibrillation and Chronic Kidney Disease; OMICS Group Incorporation.
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    ABSTRACT: Background Chronic kidney disease (CKD) increases acute and long-term mortality of many diseases. Limited data are available, in how far a preexisting non-dialysis dependent CKD affects the outcome of critically ill patients treated for non-renal causes. Methods In a retrospective study, we assessed the outcome of 524 patients with need for mechanical ventilation at our medical intensive care unit between 2002 and 2007. Patients were divided into 5 CKD stages depending on their calculated glomerular filtration rate at hospital admission excluding patients with pre-existing end-stage renal failure. In-hospital and long-term outcome up to 5 years were assessed. Results Advanced stages of CKD at admission were associated with higher age (p < 0.001) and diabetes (p = 0.003). Patients with higher CKD stages suffered more often from acute renal failure (p < 0.001), required longer renal replacement therapy (p < 0.001) and more often in-hospital resuscitation (p = 0.019). 405 patients died during follow-up (226 in-hospital). Multivariate Cox regression analysis identified eGFR as independent predictor of 30-day- (HRR 0.994, 95 % CI 0.990–0.998) and 1-year-mortality (HRR 0.996, 95 % CI 0.993–1.000). Long-term survival decreased significantly with increasing CKD stages (p = 0.004) and occurrence of acute renal failure (p < 0.001). Conclusions In critically ill patients requiring mechanical ventilation, preexisting non-dialysis dependent CKD has marked impact on occurrence of acute renal failure, 30-day- and 1-year-mortality.
    Journal of nephrology 02/2013; 27(1). DOI:10.1007/s40620-013-0016-1 · 1.45 Impact Factor
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