Elsevier

International Journal of Cardiology

Volume 185, 15 April 2015, Pages 219-223
International Journal of Cardiology

Atrial fibrillation and incident end-stage renal disease: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

https://doi.org/10.1016/j.ijcard.2015.03.104Get rights and content

Abstract

Introduction

Atrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD), however, the association between AF and incident ESRD has not been examined in the general United States population.

Methods

A total of 24,953 participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified at baseline (2003–2007) from electrocardiogram data and self-reported history. Incident cases of ESRD were identified through linkage with the United States Renal Data System. Cox proportional-hazards regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between AF and incident ESRD.

Results

A total of 2,155 (8.6%) participants had AF at baseline. Over a median follow-up of 7.4 years, 295 (1.2%) persons developed ESRD. In a model adjusted for demographics and potential confounders, AF was associated with an increased risk of incident ESRD (HR = 1.51, 95% CI = 1.08, 2.11). The association between AF and ESRD became non-significant after further adjustment for CKD markers (eGFR < 60 mL/min/1.73 m2 and urine albumin-to-creatinine ratio ≥ 30 mg/dL) (HR = 1.24, 95% CI = 0.89, 1.73).

Conclusion

AF is associated with an increased risk of ESRD in the general United States population and this association potentially is explained by underlying CKD.

Introduction

Atrial fibrillation (AF) has been estimated to affect 3 million individuals in the United States and its prevalence is projected to double by 2050 [1], [2]. Similarly, chronic kidney disease (CKD) affects 13.1% of the United States population and its prevalence is expected to increase due to the aging population and the growing epidemics of diabetes and hypertension [3].

It is well-established that CKD is a risk factor for AF. Several population-based studies have shown an increased incidence and prevalence of AF among individuals with CKD, including those with end-stage renal disease (ESRD) [4], [5], [6], [7], [8]. Recent findings also suggest that AF leads to CKD, implicating a bidirectional relationship between AF and CKD with each condition potentially influencing the development of the other. For example, data from the general Japanese population have shown that AF is associated with the development of kidney dysfunction and vice versa [9]. Additionally, a recent study has shown that incident AF was an independent predictor of ESRD development among persons with CKD [10].

The association between AF and incident ESRD has not been examined in the general United States population and whether such an association is similar in whites and blacks is unknown. Therefore, the purpose of this study was to examine the association between AF and incident ESRD using data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a large national cohort representative of the general United States population.

Section snippets

Study population and design

Details of REGARDS have been published previously [11]. Briefly, this prospective cohort study was designed to identify causes of regional and racial disparities in stroke mortality. The study over sampled blacks and residents of the southeastern stroke belt region in the United States (North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana). Between January 2003 and October 2007, a total of 30,239 participants were recruited from a commercially

Results

Of the 30,239 participants from the original REGARDS cohort, 56 were missing all data from the in-home visit and 352 participants had a diagnosis of ESRD before enrolment. Of those that remained, 513 participants with missing follow-up data, 676 participants with missing AF data, and 3,689 participants with either missing baseline characteristics or missing medication data also were excluded. A total of 24,953 study participants (mean age: 65 ± 9.0 years; 54% women; 40% blacks) were included in

Discussion

In this analysis from REGARDS, AF was associated with an increased risk of ESRD after adjustment for sociodemographics and cardiovascular risk factors. The observed association was attenuated after adjustment for markers of CKD. These findings suggest that AF is associated with ESRD in the general United States population and this association potentially is explained by underlying kidney dysfunction.

Although several reports have shown that CKD is associated with an increased prevalence of AF [4]

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Acknowledgments

This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. The authors thank the other investigators, the staff, and the participants

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