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Cardiovascular Events after New-Onset Atrial Fibrillation in Adults with CKD: Results from the Chronic Renal
Nisha Bansal1, Dawei Xie2, Daohang Sha2
1Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; nbansal@nephrology.washington.edu.
Insights
New atrial fibrillation (AF) in chronic kidney disease (CKD) patients significantly increases risks for heart failure, heart attack, stroke, and death. Early detection and intervention are crucial for cardiovascular risk reduction in CKD.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia in chronic kidney disease (CKD).
- Outcomes associated with AF in non-dialysis CKD patients are less understood.
- AF is linked to adverse outcomes in both general and end-stage renal disease (ESRD) populations.
Purpose of the Study:
- To prospectively investigate the association between new-onset AF and subsequent cardiovascular events and mortality in adults with CKD.
- To quantify the risks of heart failure, myocardial infarction, stroke, and death following AF diagnosis in this population.
Main Methods:
- Analysis of participants from the Chronic Renal Insufficiency Cohort Study without baseline AF.
- Utilized Cox regression and marginal structural models for risk assessment.
- Adjusted for demographics, laboratory values, medication use, and biomarkers.
Main Results:
- 10.5% of participants developed incident AF over a mean 6.1-year follow-up.
- Incident AF was associated with significantly higher adjusted rates of heart failure (HR 5.17), myocardial infarction (HR 3.64), stroke (HR 2.66), and death (HR 3.30).
- Associations remained robust after adjusting for inflammation, cardiac stress, mineral metabolism, and cardiac structural markers.
Conclusions:
- New-onset AF independently increases the risk of subsequent heart failure, myocardial infarction, stroke, and death by two- to five-fold in adults with CKD.
- These findings highlight the critical need for cardiovascular risk reduction strategies in CKD patients who develop AF.
- Early identification and management of AF in CKD may improve patient outcomes.
Background:
Atrial fibrillation (AF), the most common sustained arrhythmia in CKD, is associated with poor clinical outcomes in both patients without CKD and patients with dialysis-treated ESRD. However, less is known about AF-associated outcomes in patients with CKD who do not require dialysis.
Methods:
To prospectively examine the association of new-onset AF with subsequent risks of cardiovascular disease events and death among adults with CKD, we studied participants enrolled in the Chronic Renal Insufficiency Cohort Study who did not have AF at baseline. Outcomes included heart failure, myocardial infarction, stroke, and death occurring after diagnosis of AF. We used Cox regression models and marginal structural models to examine the association of incident AF with subsequent risk of cardiovascular disease events and death, adjusting for patient characteristics, laboratory values, and medication use.
Results:
Among 3080 participants, 323 (10.5%) developed incident AF during a mean 6.1 years of follow-up. Compared with participants who did not develop AF, those who did had higher adjusted rates of heart failure (hazard ratio [HR], 5.17; 95% confidence interval [95% CI], 3.89 to 6.87), myocardial infarction (HR, 3.64; 95% CI, 2.50 to 5.31), stroke (HR, 2.66; 95% CI, 1.50 to 4.74), and death (HR, 3.30; 95% CI, 2.65 to 4.12). These associations remained robust with additional adjustment for biomarkers of inflammation, cardiac stress, and mineral metabolism; left ventricular mass; ejection fraction; and left atrial diameter.
Conclusions:
Incident AF is independently associated with two- to five-fold increased rates of developing subsequent heart failure, myocardial infarction, stroke, or death in adults with CKD. These findings have important implications for cardiovascular risk reduction.
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