New-Onset Atrial Fibrillation and Accelerated Kidney Function Decline in Working-Age Adults

Area of Science:

• Cardiology
• Nephrology
• Public Health

Background:

• Early identification of cardiovascular-kidney-metabolic (CKM) syndrome is vital for preventing organ failure.
• Atrial fibrillation (AF) is a known risk factor for heart failure, but its impact on kidney function decline in younger adults remains unclear.

Purpose of the Study:

• To investigate the association between new-onset atrial fibrillation (AF) and subsequent kidney function decline in working-age adults.
• To analyze the rate of estimated glomerular filtration rate (eGFR) decline in individuals who developed new-onset AF compared to those who did not.

Main Methods:

• Retrospective cohort study using health screening and insurance claims data from Japan (April 2015-March 2023).
• Included working-age adults (35-59 years) in sinus rhythm without prior AF or kidney disease.
• New-onset AF cases were matched 1:5 with controls; eGFR decline was assessed using linear mixed-effects and Cox proportional hazards models.

Main Results:

• New-onset AF was associated with a significantly greater annual rate of eGFR decline (-1.23 mL/min/1.73 m2) compared to controls (-0.94 mL/min/1.73 m2).
• The difference in eGFR decline rate was -0.29 mL/min/1.73 m2 (P < .001).
• New-onset AF increased the incidence of a 30% or greater eGFR decline (HR, 2.91; P < .001).

Conclusions:

• New-onset atrial fibrillation accelerates kidney function decline in working-age adults.
• Further research is needed to understand the impact of AF burden and the effectiveness of AF treatments on kidney outcomes.