Estimated glomerular filtration rate within the normal or mildly impaired range and incident non-valvular atrial fibrillation: Results from a population-based cohort study

Eur J Prev Cardiol. 2017 Jan;24(2):213-222. doi: 10.1177/2047487316676132. Epub 2016 Oct 27.

Abstract

Background Lower estimated glomerular filtration rate, in particular in the significant renal impairment range (estimated glomerular filtration rate <60 ml/min/1.73 m2), is associated with incident atrial fibrillation. This association is less established within the normal or mildly impaired estimated glomerular filtration rate range. Methods Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate formula, we identified ambulatory adults (>22 years old) without rheumatic heart disease or prosthetic valves and with 60 ml/min/1.73 m2<estimated glomerular filtration rate<130 ml/min/1.73 m2 in their index visit, for incident, newly-diagnosed atrial fibrillation. We analyzed cohorts with and without prior cardiovascular disease. Results Over a mean follow-up of 104 months and >10 m patient-years of follow-up (∼75% <60 years old, ∼57% females), >65,000 individuals had ≥1 atrial fibrillation event (incident atrial fibrillation rate 5.1% and 5.8% excluding or including prior cardiovascular disease, or 49 and 55 per 10,000 patient-years, respectively). In both cohorts, individuals with versus without incident atrial fibrillation had lower mean estimated glomerular filtration rate (∼83 versus 95 ml/min/1.73 m2). Adjusting for age, gender, hypertension, and diabetes mellitus, overall a 10 ml/min/1.73 m2 decrease in estimated glomerular filtration rate was independently associated with a mean increase in incident atrial fibrillation of 1.5% and 2.4% in the cohorts excluding or including prior cardiovascular disease, respectively ( p < 0.001 for both). However, a graded association between lower estimated glomerular filtration rate and atrial fibrillation was observed in the 90-130 ml/min/1.73 m2 range, whereas a blunted association was observed in the 60-90 ml/min/1.73 m2 range. Conclusion Within the 60 ml/min/1.73 m2 < estimated glomerular filtration rate < 130 ml/min/1.73 m2 range, lower estimated glomerular filtration rate is independently associated with incident non-valvular atrial fibrillation in adults without prior atrial fibrillation, mainly attributed to a graded association within the 90-130 ml/min/1.73 m2 range.

Keywords: Kidney function; atrial fibrillation; creatinine; glomerular filtration rate; non-valvular.

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology*
  • Comorbidity
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Incidence
  • Israel / epidemiology
  • Kidney / physiopathology*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology
  • Kidney Diseases / physiopathology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Young Adult