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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Atrial Fibrillation and Risk of ESRD in Adults with CKD
Nisha Bansal1, Dawei Xie, Kelvin Tao
1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
Insights
New-onset atrial fibrillation significantly increases the risk of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD). This finding highlights the importance of managing atrial fibrillation in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Atrial fibrillation is a common complication in patients with chronic kidney disease (CKD).
- The association between atrial fibrillation and the progression to end-stage renal disease (ESRD) in CKD patients requires further elucidation.
- This study investigates the link between new-onset atrial fibrillation and the risk of ESRD in individuals with CKD.
Purpose of the Study:
- To examine the association between incident atrial fibrillation and the risk of developing ESRD in a cohort of patients with CKD.
- To provide insights into the cardiovascular and renal outcomes in patients with comorbid CKD and atrial fibrillation.
Main Methods:
- Analysis of participants from the prospective Chronic Renal Insufficiency Cohort Study without atrial fibrillation at baseline.
- Incident atrial fibrillation identified via ECGs, self-report, and diagnostic codes, confirmed by adjudication.
- ESRD ascertained through self-report, medical records, and US Renal Data System linkage.
- Marginal structural models used to adjust for time-dependent confounders.
Main Results:
- Among 3091 participants, 172 (5.6%) developed incident atrial fibrillation.
- Incident atrial fibrillation was associated with a 3.2-fold higher rate of ESRD (95% CI, 1.9 to 5.2).
- The association remained consistent across subgroups based on age, sex, race, diabetes, and baseline eGFR.
Conclusions:
- Incident atrial fibrillation is linked to an elevated risk of ESRD in patients with CKD.
- Further research is needed to identify modifiable pathways contributing to this increased risk.
- Aggressive monitoring and treatment for atrial fibrillation in CKD patients may improve outcomes.
Background And Objectives:
Atrial fibrillation frequently complicates CKD and is associated with adverse outcomes. Progression to ESRD is a major complication of CKD, but the link with atrial fibrillation has not been fully delineated. In this study, we examined the association of incident atrial fibrillation with the risk of ESRD in patients with CKD.
Design, Setting, Participants, & Measurements:
We studied participants in the prospective Chronic Renal Insufficiency Cohort Study without atrial fibrillation at entry. Incident atrial fibrillation was identified by study visit ECGs, self-report, and hospital discharge diagnostic codes, with confirmation by physician adjudication. ESRD through 2012 was ascertained by participant self-report, medical records, and linkage to the US Renal Data System. Data on potential confounders were obtained from self-report, study visits, and laboratory tests. Marginal structural models were used to study the potential association of incident atrial fibrillation with risk of ESRD after adjustment for time-dependent confounding.
Results:
Among 3091 participants, 172 (5.6%) developed incident atrial fibrillation during follow-up. During mean follow-up of 5.9 years, 43 patients had ESRD that occurred after development of incident atrial fibrillation (11.8/100 person-years) compared with 581 patients without incident atrial fibrillation (3.4/100 person-years). In marginal structural models with inverse probability weighting, incident atrial fibrillation was associated with a substantially higher rate of ESRD (hazard ratio, 3.2; 95% confidence interval, 1.9 to 5.2). This association was consistent across important subgroups by age, sex, race, diabetes status, and baseline eGFR.
Conclusions:
Incident atrial fibrillation was associated with higher risk of developing ESRD in CKD. Additional study is needed to identify potentially modifiable pathways through which atrial fibrillation was associated with a higher risk of progression to ESRD. More aggressive monitoring and treatment of patients with CKD and atrial fibrillation may improve outcomes in this high-risk population.
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