Reduced kidney function is a risk factor for atrial fibrillation

There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 s...

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Published in	Nephrology (Carlton, Vic.) Vol. 21; no. 8; pp. 717 - 720
Main Authors	Laukkanen, Jari A, Zaccardi, Francesco, Karppi, Jouni, Ronkainen, Kimmo, Kurl, Sudhir
Format	Journal Article
Language	English
Published	Australia Blackwell Publishing Ltd 01.08.2016 Wiley Subscription Services, Inc
Subjects	Aged Aged, 80 and over albumin/creatinine ratio Albuminuria - etiology Albuminuria - physiopathology atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - physiopathology Biomarkers - blood Cardiac arrhythmia Creatinine Creatinine - blood Cystatin C Cystatin C - blood Electrocardiography Epidermal growth factor receptors Female Fibrillation Finland - epidemiology Glomerular Filtration Rate Humans Incidence Kidney - physiopathology Kidney Diseases - blood Kidney Diseases - diagnosis Kidney Diseases - epidemiology Kidney Diseases - physiopathology Kidneys Male Middle Aged Population studies Predictive Value of Tests Prospective Studies prospective study Risk Factors Time Factors cystatin C atrial fibrillation albumin/creatinine ratio glomerular filtration rate prospective study
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ISSN	1320-5358 1440-1797
DOI	10.1111/nep.12727

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Abstract	There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61–82 years. Cystatin C‐ and creatinine‐based estimation of glomerular filtration rate (eGFRcys and eGRFcreat, respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow‐up of 3.7 years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56–4.81, P < 0.001) in subjects with reduced kidney function (eGFRcys, 15–59 mL/min per 1.73 m2) compared to subjects with normal kidney function (≥90 mL/min per 1.73 m2). Similar results were also found when comparing the respective groups of subjects defined by their eGRFcreat levels (hazard ratio 2.41, CI 1.09–5.30, P = 0.029). Consistently, subjects with ACR ≥300 mg/g had an increased risk of incident atrial fibrillation (hazard ratio 2.16, CI 1.35–2.82, P < 0.001) compared to those with ACR <30 mg/g. Reduced eGFR and albuminuria were associated with an increased risk of atrial fibrillation.
AbstractList	There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61–82 years. Cystatin C‐ and creatinine‐based estimation of glomerular filtration rate (eGFRcys and eGRFcreat, respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow‐up of 3.7 years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56–4.81, P < 0.001) in subjects with reduced kidney function (eGFRcys, 15–59 mL/min per 1.73 m2) compared to subjects with normal kidney function (≥90 mL/min per 1.73 m2). Similar results were also found when comparing the respective groups of subjects defined by their eGRFcreat levels (hazard ratio 2.41, CI 1.09–5.30, P = 0.029). Consistently, subjects with ACR ≥300 mg/g had an increased risk of incident atrial fibrillation (hazard ratio 2.16, CI 1.35–2.82, P < 0.001) compared to those with ACR <30 mg/g. Reduced eGFR and albuminuria were associated with an increased risk of atrial fibrillation. There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61–82 years. Cystatin C‐ and creatinine‐based estimation of glomerular filtration rate (eGFR cys and eGRF creat , respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow‐up of 3.7 years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56–4.81, P < 0.001) in subjects with reduced kidney function (eGFR cys , 15–59 mL/min per 1.73 m 2 ) compared to subjects with normal kidney function (≥90 mL/min per 1.73 m 2 ). Similar results were also found when comparing the respective groups of subjects defined by their eGRF creat levels (hazard ratio 2.41, CI 1.09–5.30, P = 0.029). Consistently, subjects with ACR ≥300 mg/g had an increased risk of incident atrial fibrillation (hazard ratio 2.16, CI 1.35–2.82, P < 0.001) compared to those with ACR <30 mg/g. Reduced eGFR and albuminuria were associated with an increased risk of atrial fibrillation. There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61-82 years. Cystatin C- and creatinine-based estimation of glomerular filtration rate (eGFRcys and eGRFcreat , respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow-up of 3.7 years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56-4.81, P < 0.001) in subjects with reduced kidney function (eGFRcys , 15-59 mL/min per 1.73 m(2) ) compared to subjects with normal kidney function (≥90 mL/min per 1.73 m(2) ). Similar results were also found when comparing the respective groups of subjects defined by their eGRFcreat levels (hazard ratio 2.41, CI 1.09-5.30, P = 0.029). Consistently, subjects with ACR ≥300 mg/g had an increased risk of incident atrial fibrillation (hazard ratio 2.16, CI 1.35-2.82, P < 0.001) compared to those with ACR <30 mg/g. Reduced eGFR and albuminuria were associated with an increased risk of atrial fibrillation. There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61-82years. Cystatin C- and creatinine-based estimation of glomerular filtration rate (eGFR sub(cys) and eGRF sub(creat), respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow-up of 3.7years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56-4.81, P<0.001) in subjects with reduced kidney function (eGFR sub(cys), 15-59mL/min per 1.73m super(2)) compared to subjects with normal kidney function ( greater than or equal to 90mL/min per 1.73m super(2)). Similar results were also found when comparing the respective groups of subjects defined by their eGRF sub(creat) levels (hazard ratio 2.41, CI 1.09-5.30, P=0.029). Consistently, subjects with ACR greater than or equal to 300mg/g had an increased risk of incident atrial fibrillation (hazard ratio 2.16, CI 1.35-2.82, P<0.001) compared to those with ACR <30mg/g. Reduced eGFR and albuminuria were associated with an increased risk of atrial fibrillation.
Author	Ronkainen, Kimmo Karppi, Jouni Laukkanen, Jari A Zaccardi, Francesco Kurl, Sudhir
Author_xml	– sequence: 1 givenname: Jari A surname: Laukkanen fullname: Laukkanen, Jari A email: jariantero.laukkanen@uef.fi organization: Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland – sequence: 2 givenname: Francesco surname: Zaccardi fullname: Zaccardi, Francesco organization: Internal Medicine and Diabetes Care Unit, Catholic University, Rome, Italy – sequence: 3 givenname: Jouni surname: Karppi fullname: Karppi, Jouni organization: Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland – sequence: 4 givenname: Kimmo surname: Ronkainen fullname: Ronkainen, Kimmo organization: Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland – sequence: 5 givenname: Sudhir surname: Kurl fullname: Kurl, Sudhir organization: Department of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Cites_doi	10.1056/NEJMoa1114248 10.1016/j.amjcard.2009.07.026 10.1161/01.CIR.0000042700.48769.59 10.1001/jama.285.18.2370 10.1016/j.cardfail.2009.07.002 10.1111/j.1540-8167.2010.01774.x 10.1161/hc4901.101760 10.1161/01.CIR.0000103131.70301.4F 10.1161/CIRCULATIONAHA.111.020982 10.1053/j.ajkd.2003.10.037 10.1016/S0140-6736(11)60178-5 10.1007/s10654-012-9753-z 10.1016/j.hrthm.2015.03.024 10.1016/j.ahj.2005.03.055
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References	Aviles RJ, Martin DO, Apperson-Hansen C et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108: 3006-10. Shlipak MG, Fried LF, Crump C et al. Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 2003; 107: 87-92. Karppi J, Kurl S, Mäkikallio TH, Ronkainen K, Laukkanen JA. Low levels of plasma carotenoids are associated with an increased risk of atrial fibrillation. Eur. J. Epidemiol. 2013; 28: 45-53. Alonso A, Lopez FL, Matsushita K, Coresh J. Chronic kidney disease is associated with the incidence of atrial fibrillation: The atherosclerosis risk in communities (ARIC) study. Circulation 2011; 123: 2946-53. Landray MJ, Wheeler DC, Lip GY et al. Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study. Am. J. Kidney Dis. 2004; 43: 244-53. Inker LA, Schmid CH, Tighiouart H et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N. Engl. J. Med. 2012; 367: 20-9. Levey AS, Coresh J. Chronic kidney disease. Lancet 2012; 379: 165-180. Patel P, Dokainish H, Tsai P, Lakkis N. Update on the association of inflammation and atrial fibrillation. J. Cardiovasc. Electrophysiol. 2010; 21: 1064-70. Astor BC, Coresh J, Heiss G, Pettitt D, Sarnak MJ. Kidney function and anemia as risk factors for coronary heart disease and mortality: The atherosclerosis risk in communities (ARIC) study. Am. Heart J. 2006; 151: 492-500. Deo R, Katz R, Kestenbaum B et al. Impaired kidney function and atrial fibrillation in elderly subjects. J. Card. Fail. 2010; 16: 55-60. McManus DD, Corteville DC, Shlipak MG, Whooley MA, Ix JH. Relation of kidney function and albuminuria with atrial fibrillation (from the heart and soul study). Am. J. Cardiol. 2009; 104: 1551-5. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am. J. Kidney Dis. 2002; 39: S1-266. Khan H, Kella D, Rauramaa R, Savonen K, Lloyd MS, Laukkanen JA. Cardiorespiratory fitness and atrial fibrillation: A population-based follow-up study. Heart Rhythm 2015; 12: 1424-30. Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The AnTicoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA 2001; 285: 2370-5. Chung MK, Martin DO, Sprecher D et al. C-reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2010; 104: 2886-91. 2004; 43 2002; 39 2015; 12 2010; 21 2010; 16 2003; 108 2003; 107 2001; 285 2013; 28 2010; 104 2006; 151 2012; 367 2012; 379 2011; 123 2009; 104 National Kidney Foundation (e_1_2_7_4_1) 2002; 39 e_1_2_7_6_1 e_1_2_7_5_1 e_1_2_7_3_1 e_1_2_7_9_1 e_1_2_7_8_1 e_1_2_7_7_1 e_1_2_7_16_1 e_1_2_7_2_1 e_1_2_7_15_1 e_1_2_7_14_1 e_1_2_7_13_1 e_1_2_7_12_1 e_1_2_7_11_1 e_1_2_7_10_1
References_xml	– reference: Aviles RJ, Martin DO, Apperson-Hansen C et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108: 3006-10. – reference: Karppi J, Kurl S, Mäkikallio TH, Ronkainen K, Laukkanen JA. Low levels of plasma carotenoids are associated with an increased risk of atrial fibrillation. Eur. J. Epidemiol. 2013; 28: 45-53. – reference: McManus DD, Corteville DC, Shlipak MG, Whooley MA, Ix JH. Relation of kidney function and albuminuria with atrial fibrillation (from the heart and soul study). Am. J. Cardiol. 2009; 104: 1551-5. – reference: Landray MJ, Wheeler DC, Lip GY et al. Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study. Am. J. Kidney Dis. 2004; 43: 244-53. – reference: Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The AnTicoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA 2001; 285: 2370-5. – reference: Levey AS, Coresh J. Chronic kidney disease. Lancet 2012; 379: 165-180. – reference: Inker LA, Schmid CH, Tighiouart H et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N. Engl. J. Med. 2012; 367: 20-9. – reference: Patel P, Dokainish H, Tsai P, Lakkis N. Update on the association of inflammation and atrial fibrillation. J. Cardiovasc. Electrophysiol. 2010; 21: 1064-70. – reference: National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am. J. Kidney Dis. 2002; 39: S1-266. – reference: Deo R, Katz R, Kestenbaum B et al. Impaired kidney function and atrial fibrillation in elderly subjects. J. Card. Fail. 2010; 16: 55-60. – reference: Alonso A, Lopez FL, Matsushita K, Coresh J. Chronic kidney disease is associated with the incidence of atrial fibrillation: The atherosclerosis risk in communities (ARIC) study. Circulation 2011; 123: 2946-53. – reference: Shlipak MG, Fried LF, Crump C et al. Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 2003; 107: 87-92. – reference: Astor BC, Coresh J, Heiss G, Pettitt D, Sarnak MJ. Kidney function and anemia as risk factors for coronary heart disease and mortality: The atherosclerosis risk in communities (ARIC) study. Am. Heart J. 2006; 151: 492-500. – reference: Chung MK, Martin DO, Sprecher D et al. C-reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2010; 104: 2886-91. – reference: Khan H, Kella D, Rauramaa R, Savonen K, Lloyd MS, Laukkanen JA. Cardiorespiratory fitness and atrial fibrillation: A population-based follow-up study. Heart Rhythm 2015; 12: 1424-30. – volume: 39 start-page: S1 year: 2002 end-page: 266 article-title: K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification publication-title: Am. J. Kidney Dis. – volume: 123 start-page: 2946 year: 2011 end-page: 53 article-title: Chronic kidney disease is associated with the incidence of atrial fibrillation: The atherosclerosis risk in communities (ARIC) study publication-title: Circulation – volume: 104 start-page: 2886 year: 2010 end-page: 91 article-title: C‐reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanisms and persistence of atrial fibrillation publication-title: Circulation – volume: 104 start-page: 1551 year: 2009 end-page: 5 article-title: Relation of kidney function and albuminuria with atrial fibrillation (from the heart and soul study) publication-title: Am. J. Cardiol. – volume: 367 start-page: 20 year: 2012 end-page: 9 article-title: Estimating glomerular filtration rate from serum creatinine and cystatin C publication-title: N. Engl. J. Med. – volume: 285 start-page: 2370 year: 2001 end-page: 5 article-title: Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The AnTicoagulation and risk factors in atrial fibrillation (ATRIA) study publication-title: JAMA – volume: 12 start-page: 1424 year: 2015 end-page: 30 article-title: Cardiorespiratory fitness and atrial fibrillation: A population‐based follow‐up study publication-title: Heart Rhythm – volume: 16 start-page: 55 year: 2010 end-page: 60 article-title: Impaired kidney function and atrial fibrillation in elderly subjects publication-title: J. Card. Fail. – volume: 151 start-page: 492 year: 2006 end-page: 500 article-title: Kidney function and anemia as risk factors for coronary heart disease and mortality: The atherosclerosis risk in communities (ARIC) study publication-title: Am. Heart J. – volume: 43 start-page: 244 year: 2004 end-page: 53 article-title: Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study publication-title: Am. J. Kidney Dis. – volume: 107 start-page: 87 year: 2003 end-page: 92 article-title: Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency publication-title: Circulation – volume: 21 start-page: 1064 year: 2010 end-page: 70 article-title: Update on the association of inflammation and atrial fibrillation publication-title: J. Cardiovasc. 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Kidney Dis. – ident: e_1_2_7_9_1 doi: 10.1016/j.cardfail.2009.07.002 – ident: e_1_2_7_12_1 doi: 10.1111/j.1540-8167.2010.01774.x – ident: e_1_2_7_13_1 doi: 10.1161/hc4901.101760 – ident: e_1_2_7_14_1 doi: 10.1161/01.CIR.0000103131.70301.4F – ident: e_1_2_7_10_1 doi: 10.1161/CIRCULATIONAHA.111.020982 – ident: e_1_2_7_15_1 doi: 10.1053/j.ajkd.2003.10.037 – ident: e_1_2_7_5_1 doi: 10.1016/S0140-6736(11)60178-5 – ident: e_1_2_7_7_1 doi: 10.1007/s10654-012-9753-z – ident: e_1_2_7_8_1 doi: 10.1016/j.hrthm.2015.03.024 – ident: e_1_2_7_3_1 doi: 10.1016/j.ahj.2005.03.055
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Snippet	There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to...
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SubjectTerms	Aged Aged, 80 and over albumin/creatinine ratio Albuminuria - etiology Albuminuria - physiopathology atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - physiopathology Biomarkers - blood Cardiac arrhythmia Creatinine Creatinine - blood Cystatin C Cystatin C - blood Electrocardiography Epidermal growth factor receptors Female Fibrillation Finland - epidemiology Glomerular Filtration Rate Humans Incidence Kidney - physiopathology Kidney Diseases - blood Kidney Diseases - diagnosis Kidney Diseases - epidemiology Kidney Diseases - physiopathology Kidneys Male Middle Aged Population studies Predictive Value of Tests Prospective Studies prospective study Risk Factors Time Factors
Title	Reduced kidney function is a risk factor for atrial fibrillation
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