Even early CKD may elevate AF risk
MedWire News: Patients with chronic kidney disease (CKD) of any severity may be at increased risk for atrial fibrillation (AF), US researchers report.
Previous studies have demonstrated a link between end-stage kidney disease and raised AF risk, but Paul Muntner, from the University of Alabama at Birmingham, and team say that their findings suggest that this risk extends to all CKD patients, including those with early disease.
"Given the large number of US adults with CKD and their high risk of CVD, these findings have important clinical implications," the team explains.
Muntner and colleagues calculated the rate of electrocardiography (ECG)-detected AF among 26,917 African-American and Caucasian participants aged at least 45 years.
In all, 21,081 patients had no CKD (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73m2 without albuminuria), 2938 patients had stage 1-2 CKD (eGFR ≥60 ml/min/1.73m2 with albuminuria), 2683 patients had stage 3 CKD (eGFR 30-59 ml/min/1.73m2), and 215 patients had stage 4-5 CKD (eGFR <30 ml/min/1.73m2).
Albuminuria was defined as a urinary albumin to creatinine ratio ≥30 mg/g, and eGFR was calculated using the abbreviated Modification of Diet in Renal Disease study equation.
The findings, reported in the journal Circulation: Arrhythmia and Electrophysiology, show that AF occurred significantly more frequently in patients with stages 1-2, 3, and 4-5 CKD than in those with no CKD, at rates of 2.8%, 2.7%, and 4.2% versus 1.0%, respectively.
After adjustment for age, gender, and race, patients with CKD of any severity still had a higher AF risk than those without CKD, with 2.67-, 1.68-, and 3.52-fold increased AF risk among patients with stage 1-2, 3, and 4-5 CKD, respectively (p<0.001).
Further analysis revealed that the increased AF risk identified in patients with CKD persisted regardless of race and even when the presence of AF was assessed by self-report rather than ECG.
The researchers conclude: "Additional prospective studies are needed to determine the mechanisms responsible for this association."
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By Lauretta Ihonor