Nisha Bansal1, Dawei Xie2, Daohang Sha2, Lawrence J Appel3, Rajat Deo2, Harold I Feldman2, Jiang He4, Kenneth Jamerson5, John W Kusek6, Steven Messe2, Sankar D Navaneethan7, Mahboob Rahman8, Ana Catherine Ricardo9, Elsayed Z Soliman10, Raymond Townsend2, Alan S Go11,12,13. 1. Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; nbansal@nephrology.washington.edu. 2. Departments of Medicine and Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Medicine, Johns Hopkins University, Baltimore, Maryland. 4. Department of Medicine, Tulane University, New Orleans, Louisiana. 5. Department of Medicine, University of Michigan, Ann Arbor, Michigan. 6. National Institutes of Health, Bethesda, Maryland. 7. Department of Medicine, Baylor College of Medicine, Houston, Texas. 8. Department of Medicine, University Hospitals, Case Western Reserve University, Cleveland, Ohio. 9. Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. 10. Department of Medicine, Wake Forest University, Winston-Salem, North Carolina. 11. Kaiser Permanente Northern California, Oakland, California. 12. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; and. 13. Department of Health Research and Policy, Stanford University, Stanford, California.
Abstract
BACKGROUND: Atrial fibrillation (AF), the most common sustained arrhythmia in CKD, is associated with poor clinical outcomes in both patients without CKD and patients with dialysis-treated ESRD. However, less is known about AF-associated outcomes in patients with CKD who do not require dialysis. METHODS: To prospectively examine the association of new-onset AF with subsequent risks of cardiovascular disease events and death among adults with CKD, we studied participants enrolled in the Chronic Renal Insufficiency Cohort Study who did not have AF at baseline. Outcomes included heart failure, myocardial infarction, stroke, and death occurring after diagnosis of AF. We used Cox regression models and marginal structural models to examine the association of incident AF with subsequent risk of cardiovascular disease events and death, adjusting for patient characteristics, laboratory values, and medication use. RESULTS: Among 3080 participants, 323 (10.5%) developed incident AF during a mean 6.1 years of follow-up. Compared with participants who did not develop AF, those who did had higher adjusted rates of heart failure (hazard ratio [HR], 5.17; 95% confidence interval [95% CI], 3.89 to 6.87), myocardial infarction (HR, 3.64; 95% CI, 2.50 to 5.31), stroke (HR, 2.66; 95% CI, 1.50 to 4.74), and death (HR, 3.30; 95% CI, 2.65 to 4.12). These associations remained robust with additional adjustment for biomarkers of inflammation, cardiac stress, and mineral metabolism; left ventricular mass; ejection fraction; and left atrial diameter. CONCLUSIONS: Incident AF is independently associated with two- to five-fold increased rates of developing subsequent heart failure, myocardial infarction, stroke, or death in adults with CKD. These findings have important implications for cardiovascular risk reduction.
BACKGROUND:Atrial fibrillation (AF), the most common sustained arrhythmia in CKD, is associated with poor clinical outcomes in both patients without CKD and patients with dialysis-treated ESRD. However, less is known about AF-associated outcomes in patients with CKD who do not require dialysis. METHODS: To prospectively examine the association of new-onset AF with subsequent risks of cardiovascular disease events and death among adults with CKD, we studied participants enrolled in the Chronic Renal Insufficiency Cohort Study who did not have AF at baseline. Outcomes included heart failure, myocardial infarction, stroke, and death occurring after diagnosis of AF. We used Cox regression models and marginal structural models to examine the association of incident AF with subsequent risk of cardiovascular disease events and death, adjusting for patient characteristics, laboratory values, and medication use. RESULTS: Among 3080 participants, 323 (10.5%) developed incident AF during a mean 6.1 years of follow-up. Compared with participants who did not develop AF, those who did had higher adjusted rates of heart failure (hazard ratio [HR], 5.17; 95% confidence interval [95% CI], 3.89 to 6.87), myocardial infarction (HR, 3.64; 95% CI, 2.50 to 5.31), stroke (HR, 2.66; 95% CI, 1.50 to 4.74), and death (HR, 3.30; 95% CI, 2.65 to 4.12). These associations remained robust with additional adjustment for biomarkers of inflammation, cardiac stress, and mineral metabolism; left ventricular mass; ejection fraction; and left atrial diameter. CONCLUSIONS: Incident AF is independently associated with two- to five-fold increased rates of developing subsequent heart failure, myocardial infarction, stroke, or death in adults with CKD. These findings have important implications for cardiovascular risk reduction.
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