Journal Article

Chronic kidney disease and prevalent atrial fibrillation: The Chronic Renal Insufficiency Cohort (CRIC)

Lash, James P., Rahman, Mahboob, Dries, Daniel L., Soliman, Elsayed Z., Ojo, Akinlolu, Teal, Val L., Mohler, Emile R., Wright, Jackson T., Feldman, Harold I., Prineas, Ronald J., Bazzano, Lydia, Xie, Dawei, Robinson, Nancy L., Jensvold, Nancy G., Go, Alan S.

2010

Overview

The epidemiology of atrial fibrillation (AF) has been mainly investigated in patients with end-stage renal disease, with limited data on less advanced chronic kidney disease (CKD) stages. A total of 3,267 adult participants (50% non-Hispanic blacks, 46% women) with CKD from the Chronic Renal Insufficiency Cohort were included in this study. None of the study participants had been on dialysis. Those with self-identified race/ethnicity other than non-Hispanic black or white (n = 323) or those without electrocardiographic data (n = 22) were excluded. Atrial fibrillation was ascertained by a 12-lead electrocardiogram and self-report. Age-, sex-, and race/ethnicity-specific prevalence rates of AF were estimated and compared between subgroups. Cross-sectional associations and correlates with prevalent AF were examined using unadjusted and multivariable-adjusted logistic regression analysis. The mean estimated glomerular filtration rate was 43.6 (±13.0) mL/(min 1.73 m 2). Atrial fibrillation was present in 18% of the study population and in >25% of those ≥70 years old. In multivariable-adjusted models, 1-SD increase in age (11 years) (odds ratio 1.27, CI 95% 1.13-1.43, P < .0001), female sex (0.80, 0.65-0.98, P = .0303), smoking (former vs never) (1.34, 1.08-1.66, P = .0081), history of heart failure (3.28, 2.47-4.36, P < .001), and history of cardiovascular disease (1.94, 1.56-2.43, P < .0001) were significantly associated with AF. Race/ethnicity, hypertension, diabetes, body mass index, physical activity, education, high-sensitivity C-reactive protein, total cholesterol, and alcohol intake were not significantly associated with AF. An estimated glomerular filtration rate <45 mL/(min 1.73 m 2) was associated with AF in an unadjusted model (1.35, 1.13-1.62, P = .0010), but not after multivariable adjustment (1.12, 0.92-1.35, P = .2710). Nearly 1 in 5 participants in Chronic Renal Insufficiency Cohort, a national study of CKD, had evidence of AF at study entry, a prevalence similar to that reported among patients with end-stage renal disease and 2 to 3 times of that reported in the general population. Risk factors for AF in this CKD population do not mirror those reported in the general population.

• Publisher: Mosby, Inc,Mosby,Elsevier Limited
• Subject: Adult / Age / Aged / Atrial Fibrillation - epidemiology / Atrial Fibrillation - etiology / Atrial Fibrillation - physiopathology / Biological and medical sciences / Blood pressure / Body mass index / Cardiac dysrhythmias / Cardiology. Vascular system / Cardiovascular / Cardiovascular disease / Cholesterol / College graduates / Colleges & universities / Diabetes / Education / Electrocardiography / Ethnicity / Family medical history / Female / Follow-Up Studies / Glomerular Filtration Rate / Heart / Heart attacks / Heart failure / Heart Rate / Humans / Hypertension / Kidney diseases / Kidney Failure, Chronic - complications / Kidney Failure, Chronic - epidemiology / Kidney Failure, Chronic - physiopathology / Kidneys / Logistics / Male / Medical sciences / Medical treatment / Middle Aged / Nephrology. Urinary tract diseases / Nephropathies. Renovascular diseases. Renal failure / Population / Prevalence / Prospective Studies / Renal failure / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - epidemiology / Renal Insufficiency, Chronic - physiopathology / Secondary schools / United States - epidemiology / Urinary system involvement in other diseases. Miscellaneous / Young Adult