Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.
Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.
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DOI：
10.1161/circulationaha.111.020982
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发表时间：
2011-06-28
期刊：
影响因子：
37.8
通讯作者：
Coresh J
中科院分区：
文献类型：
--
作者：
Alonso A;Lopez FL;Matsushita K;Loehr LR;Agarwal SK;Chen LY;Soliman EZ;Astor BC;Coresh J
慢性肾脏病（CKD）与心血管疾病的发病率相关。CKD也可能增加房颤（AF）的风险，但现有研究报告的结果不一致。我们在1996- 1998年的动脉粥样硬化风险社区研究（ARIC）中评估了10,328名无AF男性和女性的基于胱抑素C的肾小球滤过率（eGFRcys）和测量了尿白蛋白-肌酐比值（ACR）。AF的发病率已确定至2007年底。在中位随访10.1年期间，我们确定了788例AF事件。与eGFRcys ≥90 mL/min/1.73 m2的个体相比，AF的多变量风险比（HR）和95%置信区间（CI）为1.3在eGFRcys为60-89、30-59和15-29 mL/min/1.73 m2的患者中，分别为（1.1-1.6）、1.6（1.3-2.1）和3.2（2.0-5.0）（趋势p <0.0001）。同样，与ACR <30 mg/g的患者相比，大量白蛋白尿（ACR ≥300 mg/g，HR 3.2，95% CI 2.3-4.5）和微量白蛋白尿（ACR 30-299 mg/g，HR 2.0，95% CI 1.6-2.4）的存在与更高的AF风险相关。低eGFRcys和大量白蛋白尿患者的AF风险尤其升高（HR 13.1，95% CI 6.0-28.6，比较ACR≥300 mg/g和eGFRcys 15-29与ACR<30 mg/g和eGFRcys ≥90 mL/min/1.73 m2的个体）。在这项基于大规模人群的研究中，肾功能下降和白蛋白尿的存在与AF的发病率密切相关，独立于其他风险因素。
Chronic kidney disease (CKD) is associated with the incidence of cardiovascular disease. CKD may also increase the risk of atrial fibrillation (AF), but existing studies have reported inconsistent results. We estimated cystatin C-based glomerular filtration rate (eGFRcys) and measured urinary albumin-creatinine ratio (ACR) in 10,328 men and women free of AF from the Atherosclerosis Risk in Communities (ARIC) Study in 1996–98. Incidence of AF was ascertained through the end of 2007. During a median follow-up of 10.1 years, we identified 788 incident AF cases. Compared to individuals with eGFRcys ≥90 mL/min/1.73 m2, multivariable hazard ratios (HR) and 95% confidence intervals (CI) of AF were 1.3 (1.1–1.6), 1.6 (1.3–2.1), and 3.2 (2.0–5.0) (p for trend <0.0001) in those with eGFRcys of 60–89, 30–59 and 15–29 mL/min/1.73 m2, respectively. Similarly, presence of macroalbuminuria (ACR ≥300 mg/g, HR 3.2, 95% CI 2.3–4.5) and microalbuminuria (ACR 30–299 mg/g, HR 2.0, 95% CI 1.6–2.4) were associated with higher AF risk compared to those with ACR <30 mg/g. Risk of AF was particularly elevated in those with both low eGFRcys and macroalbuminuria (HR 13.1, 95% CI 6.0–28.6, comparing individuals with ACR≥300 mg/g and eGFRcys 15–29 vs. ACR<30 mg/g and eGFRcys ≥90 mL/min/1.73 m2). In this large population-based study, reduced kidney function and presence of albuminuria were strongly associated with the incidence of AF independently of other risk factors.