Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function.
Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function.
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DOI：
10.1161/jaha.117.005685
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发表时间：
2017-07-06
影响因子：
5.4
通讯作者：
Sood MM
中科院分区：
文献类型：
--
作者：
Molnar AO;Eddeen AB;Ducharme R;Garg AX;Harel Z;McCallum MK;Perl J;Wald R;Zimmerman D;Sood MM
早期证据表明蛋白尿与房颤（AF）事件独立相关。我们试图调查蛋白尿与房颤的关联是否会因肾功能而改变。回顾性队列研究，使用加拿大安大略省的行政保健数据库（2002-2015）。共纳入736666例年龄≥40岁、未接受透析且既往无房颤病史的患者。蛋白尿的定义采用尿白蛋白与肌酐比值（ACR）和肾小球滤过率（eGFR）估算的肾功能。主要转归是发生房颤的时间。Cox比例模型用于确定因死亡、透析、肾移植或随访结束而导致房颤的风险比。使用精细和灰色模型来确定房颤的亚分布风险比，死亡是一个竞争事件。中位随访时间为6年，44809例患者发生房颤。在调整后的模型中，ACR和eGFR与房颤相关（P<0.0001）。蛋白尿与房颤的相关性因肾功能而异（ACR × eGFR相互作用，P<0.0001）。明显蛋白尿（ACR, 120 mg/mmol）与肾功能完好（eGFR, 120）患者相比，肾功能降低（eGFR, 30）患者的AF风险更高（校正风险比分别为4.5 [95% CI, 4.0-5.1]和2.6 [95% CI, 2.4-2.8]；参考ACR为0和eGFR为120）。竞争风险分析的结果相似。与肾功能下降的患者相比，蛋白尿明显增加肾功能完好的患者发生房颤的风险。筛查和预防策略应考虑蛋白尿作为房颤的独立危险因素。
Early evidence suggests proteinuria is independently associated with incident atrial fibrillation (AF). We sought to investigate whether the association of proteinuria with incident AF is altered by kidney function. Retrospective cohort study using administrative healthcare databases in Ontario, Canada (2002–2015). A total of 736 666 patients aged ≥40 years not receiving dialysis and with no previous history of AF were included. Proteinuria was defined using the urine albumin‐to‐creatinine ratio (ACR) and kidney function by the estimated glomerular filtration rate (eGFR). The primary outcome was time to AF. Cox proportional models were used to determine the hazard ratio for AF censored for death, dialysis, kidney transplant, or end of follow‐up. Fine and Grey models were used to determine the subdistribution hazard ratio for AF, with death as a competing event. Median follow‐up was 6 years and 44 809 patients developed AF. In adjusted models, ACR and eGFR were associated with AF (P<0.0001). The association of proteinuria with AF differed based on kidney function (ACR × eGFR interaction, P<0.0001). Overt proteinuria (ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact (eGFR, 120) versus reduced (eGFR, 30) kidney function (adjusted hazard ratios, 4.5 [95% CI, 4.0–5.1] and 2.6 [95% CI, 2.4–2.8], respectively; referent ACR 0 and eGFR 120). Results were similar in competing risk analyses. Proteinuria increases the risk of incident AF markedly in patients with intact kidney function compared with those with decreased kidney function. Screening and preventative strategies should consider proteinuria as an independent risk factor for AF.