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Published on: February 26, 2013
Kidney Function, Albuminuria, and Risk of Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis
Jeffrey T Ha1, S Ben Freedman2, Dearbhla M Kelly3
1The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia.
Insights
Chronic kidney disease (CKD) markers, including lower estimated glomerular filtration rate (eGFR) and albuminuria, are independently linked to a higher risk of developing new-onset atrial fibrillation (AF). This suggests CKD should be recognized as a significant risk factor for AF.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist, but CKD's role as an independent risk factor for incident AF remains unclear.
- This study investigates the association between CKD markers (eGFR and albuminuria) and the risk of developing new-onset AF.
Approach:
- A systematic review and meta-analysis of 38 cohort studies and randomized controlled trials.
- Included data from over 28 million participants, analyzing incident AF risk based on eGFR and albuminuria levels.
Key Points:
- Lower eGFR (<60 mL/min/1.73m² vs ≥60) was associated with a 43% increased risk of incident AF (RR, 1.43; 95% CI, 1.30-1.57).
- Albuminuria, particularly moderate to severe levels, was linked to a 64% higher risk of incident AF (RR, 1.64; 95% CI, 1.31-2.06).
- An exposure-dependent association was observed, with risk increasing progressively at lower eGFR and higher albuminuria categories.
Conclusions:
- Reduced eGFR and increased albuminuria are independently associated with a significantly higher risk of incident AF.
- CKD should be considered an independent risk factor for the development of atrial fibrillation.
Rationale & Objective:
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist. However, it is not known whether CKD is an independent risk factor for incident AF. Therefore, we evaluated the association between markers of CKD-estimated glomerular filtration rate (eGFR) and albuminuria-and incident AF.
Study Design:
Systematic review and meta-analysis of cohort studies and randomized controlled trials.
Setting & Study Populations:
Participants with measurement of eGFR and/or albuminuria who were not receiving dialysis.
Selection Criteria For Studies:
Cohort studies and randomized controlled trials were included that reported incident AF risk in adults according to eGFR and/or albuminuria.
Analytical Approach:
Age- or multivariate-adjusted risk ratios (RRs) for incident AF were extracted from cohort studies, and RRs for each trial were derived from event data. RRs for incident AF were pooled using random-effects models.
Results:
38 studies involving 28,470,249 participants with 530,041 incident AF cases were included. Adjusted risk of incident AF was greater among participants with lower eGFR than those with higher eGFR (eGFR<60 vs≥60mL/min/1.73m2: RR, 1.43; 95% CI, 1.30-1.57; and eGFR<90 vs≥90mL/min/1.73m2: RR, 1.42; 95% CI, 1.26-1.60). Adjusted incident AF risk was greater among participants with albuminuria (any albuminuria vs no albuminuria: RR, 1.43; 95% CI, 1.25-1.63; and moderately to severely increased albuminuria vs normal to mildly increased albuminuria: RR, 1.64; 95% CI, 1.31-2.06). Subgroup analyses showed an exposure-dependent association between CKD and incident AF, with the risk increasing progressively at lower eGFR and higher albuminuria categories.
Limitations:
Lack of patient-level data, interaction between eGFR and albuminuria could not be evaluated, possible ascertainment bias due to variation in the methods of AF detection.
Conclusions:
Lower eGFR and greater albuminuria were independently associated with increased risk of incident AF. CKD should be regarded as an independent risk factor for incident AF.
Plain-Language Summary:
Irregular heartbeat, or atrial fibrillation (AF), is the commonest abnormal heart rhythm. AF occurs commonly in people with chronic kidney disease (CKD), and CKD is also common in people with AF. However, CKD in not widely recognized as a risk factor for new-onset or incident AF. In this research, we combined data on more than 28 million participants in 38 studies to determine whether CKD itself increases the chances of incident AF. We found that both commonly used markers of kidney disease (estimated glomerular filtration rate and albuminuria, ie, protein in the urine) were independently associated with a greater risk of incident AF. This finding suggests that CKD should be recognized as an independent risk factor for incident AF.
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