Kidney Disease Raises Risk of Atrial Fibrillation

Patients with kidney disease face a higher risk for atrial fibrillation, according to a recent meta-analysis. Factors specifically associated with a higher risk of atrial fibrillation include a reduced estimated glomular filtration rate (eGFR) and an elevated urine albumin-to-creatinine ratio.

The incidence of atrial fibrillation is high among patients with end-stage renal disease, but little is known about the incidence of atrial fibrillation among other kidney conditions.
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To explore this further, the researchers assessed 16,769 participants who did not have prevalent atrial fibrillation and were enrolled in the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study.

Cox regression models were used to examine the association of eGFR and urine albumin-to-creatinine ratio with incident atrial fibrillation. Categories of eGFR measured in the analysis included more than 90 (reference), 60 to 89, 45 to 59, 30 to 44, and less than 30 ml/min per 1.73 m². Categories of albumin-to-creatinine ratio were less than 15, 15-29, 30-299, and 300 mg/g or more.

Results were adjusted for demographic factors and comorbidities, and were further adjusted in additional analyses for measures of subclinical cardiovascular disease via electrocardiogram and cardiac imaging, and for interim heart failure (HF) and myocardial infarction (MI) events.

After analyzing the data, the researchers found a stepwise increase in the adjusted risk of incident atrial fibrillation across categories of decreasing eGFR (hazard ratios: 1.00 for patients in the more than 90 group, 1.09 for the 60-89 group, 1.17 for the 45-59 group, 1.59 for the 30-44 group, and 2.03 for the less than 30 group), as well as for increasing urine albumin-to-creatinine ratio (hazard ratios: 1.00 for patients in the less than 15 group, 1.04 for the 15-29 group, 1.47 for the 30-299 group, and 1.76 for the 300 or more group).

These associations remained consistent after results were adjusted for subclinical cardiovascular disease measures and interim HF and MI events.

“In this meta-analysis of three cohorts, reduced eGFR and elevated urine albumin-to-creatinine ratio were significantly associated with greater risk of incident atrial fibrillation, highlighting the need for further studies to understand mechanisms linking kidney disease with atrial fibrillation,” the researchers concluded.

—Christina Vogt

Reference:

Bansal N, Zeinick LR, Alonso A, et al. eGFR and albuminuria in relation to risk of incident atrial fibrillation: a meta-analysis of the Jackson heart study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study [Published online August 2017]. Clin J Am Soc Nephrol. doi:10.2215/​CJN.01860217.