Association of Loop Diuretic Use with Hospitalization with Atrial Fibrillation in CKD

CKD is associated with a high burden of cardiovascular complications, including atrial fibrillation. While loop diuretic medications are commonly prescribed for volume and blood pressure management in CKD, their relationship with incident atrial fibrillation in this population remains poorly understood.

Using data from 4,607 patients without baseline atrial fibrillation from the Chronic Renal Insufficiency Cohort (CRIC), we used adjusted Cox regression models to explore the association of baseline loop diuretic use with hospitalization with atrial fibrillation. We tested for differential associations according to sex, history of heart failure, and baseline CKD stage category. Models adjusted for demographics, cardiovascular risk factors, kidney function (eGFR), laboratory parameters (albumin, hematocrit, log 24-hour urine protein), and the use of cardiovascular medications.

The mean age of subjects at baseline was 59 ±11 years, 44% were female, and 42% were Black. The mean follow-up was 9.3 years, during which time 614 participants experienced a hospitalization with atrial fibrillation. Baseline loop diuretic therapy was associated with a 41% higher risk of hospitalization with atrial fibrillation (adjusted hazard ratio 1.41, 95% CI 1.14, 1.73). There was no effect modification by sex or CKD stage (P-interactions=0.52 and 0.29, respectively). The association appeared stronger among those with vs. without heart failure (aHR 3.00; 95% CI 1.22, 7.37 vs aHR 1.33; 95% CI 1.06, 1.66), although the interaction did not reach statistical significance (P-interaction=0.06).

Among patients with CKD and without a history of atrial fibrillation, the use of loop diuretics is independently associated with subsequent hospitalization with atrial fibrillation. This association appeared to be more potent among those with (vs. without) a history of heart failure. The etiology of the observed association requires further investigation.