Anemia and Reduced Kidney Function as Risk Factors for New Onset of Atrial Fibrillation (from the Ibaraki Prefectural Health Study)
Anemia and Reduced Kidney Function as Risk Factors for New Onset of Atrial Fibrillation (from the Ibaraki Prefectural Health Study)
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DOI：
10.1016/j.amjcard.2014.10.041
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发表时间：
2015-02-01
影响因子：
2.8
通讯作者：
Aonuma, Kazutaka
中科院分区：
文献类型：
--
作者：
Xu, DongZhu;Murakoshi, Nobuyuki;Aonuma, Kazutaka
慢性肾脏病（CKD）是房颤（AF）的潜在独立危险因素。尚不清楚贫血是否与CKD受试者AF发作风险增加协同相关。我们在一项基于人群的队列研究中评估了肾功能、血红蛋白（Hb）及其组合与新发AF的相关性。我们对132，250名年龄在40至79岁之间的日本受试者进行了一项为期15年的前瞻性队列研究，这些受试者从1993年起参加了年度健康检查。Kaplan-Meier生存分析用于比较按估计肾小球滤过率分级、Hb分级及其组合分类的组间新发AF的发生率。考克斯比例风险模型分析用于估计新发AF的风险比（HR）。在平均13.8年的随访期间，确定了1，232例（0.93%）新发AF受试者。轻度CKD组新发AF的多变量HR和95%可信区间（CI）分别为1.38（1.21 ~ 1.56）、2.56（2.09 ~ 3.13）和1.50（1.24 ~ 1.83）。血红蛋白临界水平与新发房颤风险增加无显著相关性（HR 1.07，CI 0.91 - 1.25，p = 0.4284）。在CKD和贫血之间的相互作用项的模型中，风险显著高于每个因素独立预测的风险（相互作用p = 0.0343）。总之，肾功能下降和Hb水平降低与新发AF风险增加相关，尤其是当两者同时存在时。(C)2015 Elsevier Inc. All rights reserved.
Chronic kidney disease (CKD) is a potential independent risk factor for atrial fibrillation (AF). It remains unclear whether anemia is synergistically associated with increased risk of AF onset in subjects with CKD. We evaluated the association of kidney function, hemoglobin (Hb), and their combination with new-onset AF in a population-based cohort study. We conducted a 15-year prospective cohort study of 132,250 Japanese subjects aged 40 to 79 years who participated in annual health checkups from 1993. Kaplan-Meier survival analysis was used to compare freedom from new-onset AF between groups classified by estimated glomerular filtration rate grade, Hb grade, and their combination. Cox proportional hazard model analysis was used to estimate hazard ratios (HRs) for new-onset AF. During a 13.8-year mean follow-up period, 1,232 (0.93%) subjects with new-onset AF were identified. Lower estimated glomerular filtration rate and lower Hb grades were significantly associated with a higher incidence of new-onset AF. Multivariate HRs and 95% confidence intervals (CIs) of new-onset AF were 1.38 (1.21 to 1.56) for mild CKD group, 2.56 (2.09 to 3.13) for CKD group, and 1.50 (1.24 to 1.83) for anemia group. Borderline Hb level was not significantly associated with increased risk for new-onset AF (HR 1.07, CI 0.91 to 1.25, p = 0.4284). In the model with interaction term between CKD and anemia, the risk was significantly higher (p = 0.0343 for the interaction) than that predicted by each factor independently. In conclusion, decreased kidney function and lower Hb level are associated with increased risk for new-onset AF, especially when both are present. (C) 2015 Elsevier Inc. All rights reserved.