Patients with decreasing kidney function have a greater risk for atrial fibrillation, emphasizing a need for more research to uncover the underlying mechanisms that link kidney disease with atrial fibrillation, according to a study published in the Clinical Journal of the American Society of Nephrology.
Preventive interventions to maintain a regular heartbeat may benefit patients with poor kidney function, according to the researchers.
“Atrial fibrillation is the most common sustained arrhythmia in the general population,” Nisha Bansal, MD, from the division of nephrology at the University of Washington, and colleagues wrote. “The prevalence of [atrial fibrillation] is particularly high among patients with kidney disease, occurring in 7% to 20% of those with end-stage renal disease on dialysis, which is 2- to-3-fold higher than in the general population.”
However, “limited data are available on the incidence of atrial fibrillation across a broad range of kidney function,” they added.
Bansal and colleagues conducted a meta-analysis of three prospective cohorts — the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis and Cardiovascular Health Study — which included 16,769 participants without prevalent atrial fibrillation to determine if estimated glomerular filtration rate and urine albumin-to-creatinine ratio are associated with risk of incident atrial fibrillation. The researchers performed Cox regression while adjusting for demographics and comorbidity.
Results showed that the adjusted risk for incident atrial fibrillation increased gradually among several categories of reduced estimated glomerular filtration rate, compared with the reference rate of 90 ml/min/1.73 m2: 60 to 89 ml/min/1.73 m2 (HR = 1.09; 95% CI, 0.97-1.24); 45 to 59 ml/min/1.73 m2 (HR = 1.17; 95% CI, 1-1.38); 30 to 44 ml/min/1.73 m2 (HR = 1.59; 95% CI, 1.28-1.98); and less than 30 ml/min/1.73 m² (HR = 2.03; 95% CI, 1.4-2.96).
The risk for atrial fibrillation also increased with elevated urine albumin-creatinine ratio compared with the reference rate of less than 15 mg/g: 15 to 29 mg/g (HR = 1.04; 95% CI, 0.83-1.3); 30 to 299 mg/g (HR = 1.47; 95% CI, 1.2-1.79); and more than 300 mg/g (HR = 1.76; 95% CI, 1.18-2.62).
The risk for atrial fibrillation was double in patients with severe kidney disease compared with those without kidney disease. The associations remained after adjusting for measures of subclinical CVD, interim heart failure and myocardial infarction events, and was consistent across subgroups categorized by age, sex, race and comorbidity.
“This study found that even modest abnormalities in kidney function were linked with a higher risk of developing atrial fibrillation later in life,” Bansal said in a press release. “Atrial fibrillation may affect the selection of cardiovascular therapies and is associated with poor clinical outcomes. Thus, an understanding of the risk of atrial fibrillation across a broad range of kidney function is important.” – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.