Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study

Abstract

Background: Chronic kidney disease is associated with the incidence of cardiovascular disease. Chronic kidney disease may also increase the risk of atrial fibrillation (AF), but existing studies have reported inconsistent results.

Methods and results: We estimated cystatin C-based glomerular filtration rate (eGFR(cys)) and measured urinary albumin-to-creatinine ratio (ACR) in 10 328 men and women free of AF from the Atherosclerosis Risk in Communities (ARIC) Study in 1996 to 1998. Incidence of AF was ascertained through the end of 2007. During a median follow-up of 10.1 years, we identified 788 incident AF cases. Compared with individuals with eGFR(cys) ≥90 mL · min(-1) · 1.73 m(-2), multivariable hazard ratios and 95% confidence intervals (CIs) of AF were 1.3 (95% CI, 1.1 to 1.6), 1.6 (95% CI, 1.3 to 2.1), and 3.2 (95% CI, 2.0 to 5.0; P for trend <0.0001) in those with eGFR(cys) of 60 to 89, 30 to 59, and 15 to 29 mL · min(-1) · 1.73 m(-2), respectively. Similarly, the presence of macroalbuminuria (ACR ≥300 mg/g; hazard ratio, 3.2; 95% CI, 2.3 to 4.5) and microalbuminuria (ACR, 30 to 299 mg/g; hazard ratio, 2.0; 95% CI, 1.6 to 2.4) was associated with higher AF risk compared with those with ACR <30 mg/g. Risk of AF was particularly elevated in those with both low eGFR(cys) and macroalbuminuria (hazard ratio, 13.1; 95% CI, 6.0 to 28.6, comparing individuals with ACR ≥300 mg/g and eGFR(cys) of 15 to 29 mL · min(-1) · 1.73 m(-2) and those with ACR <30 mg/g and eGFR(cys) ≥90 mL · min(-1) · 1.73 m(-2)).

Conclusion: In this large population-based study, reduced kidney function and presence of albuminuria were strongly associated with the incidence of AF independently of other risk factors.

Figure 1

Survival free of atrial fibrillation (AF) by categories of eGFR_cys (90+, 60–89, <60 mL/min/1.73 m²) in whites (top panel) and African-Americans (bottom panel), ARIC 1996–2007. Cox proportional hazards model adjusted for age, gender, study site, education, height, high sensitivity C-reactive protein, body mass index, systolic blood pressure, prevalent cardiovascular disease, smoking, alcohol intake, and use of antihypertensive medication.

Figure 2

Hazard ratios (HR) and 95% confidence interval (CI) of atrial fibrillation according to urinary albumin-creatinine ratio and estimated glomerular filtration rate from blood cystatin C, ARIC, 1996–2007. Cox proportional hazard model adjusted for age, gender, race, study site, education, income, height, smoking, drinking status, diabetes, systolic blood pressure, use of antihypertensive medication, body mass index, high sensitivity C-reactive protein, prevalent coronary heart disease, and prevalent heart failure.