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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    • "Compared to the general population, the prevalence of AF is two to three times higher in those with chronic kidney disease (CKD).678 In patients with CKD, incident AF is associated with an increase in mortality and progression to end-stage renal disease.[9,10] Therefore, risk assessment is of utmost importance in order to improve primary and secondary prevention of AF and its consequences in CKD patients. "
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