[Chronic renal disease and atrial fibrillation in patients with chronic heart failure]

To specify an association between reduced renal function and atrial fibrillation (AF) in patients with chronic heart failure (CHF).

Three hundred and forty patients (200 males and 140 females, mean age 58 +/- 13 years) with CHF were examined. The causes of CHF were arterial hypertension in 44 (13%) patients, coronary heart disease (CHD) in 112 (33%), and their concomitance in 184 (54%). Sixty-six (19%) patients had diabetes mellitus and 180 (53%) had sustained myocardial infarction. Glomerular filtration rate (GFR) was calculated using the MDRD (Modification of Diet in Renal Disease) formula. Thirty patients presented with paroxysmal persistent AF and 27 had continuous AF.

GFR was 68.8 +/- 20.9 ml/min/1.73 m2 (19.2 to 149.7 ml/min/1.73 m2), 114 (33.5%) patients having a GFR of < 60 ml/min/1.73 m2. Proteinuria was observed in 38 (11.2%) patients. GFR was lower in patients with CHF and AF (58.8 +/- 14.2 ml/min/1.73 m2 than that in those without AF (69.1 +/- 18.8 ml/min/1.73 m2; p < 0.001). The patients with decreased renal function had a larger diameter of the left atrium and more commonly mitral regurgitation. Logistic regression analysis revealed that chronic renal disease (CRD) (relative risk (RR) 2.3, 95% confidence interval (CI) 1.2 to 4.3), functional class CHF (RR, 1.8, 95% CI 1.0 to 3.1) were independently associated with AF.

Decreased renal function predisposes to the development of AF in patients CHF. CRD should be considered as a condition presenting a risk for AF.