Incident atrial fibrillation and risk of end-stage renal disease in adults with chronic kidney disease.
Incident atrial fibrillation and risk of end-stage renal disease in adults with chronic kidney disease.
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DOI：
10.1161/circulationaha.112.123992
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发表时间：
2013-02-05
期刊：
影响因子：
37.8
通讯作者：
Go AS
中科院分区：
文献类型：
--
作者：
Bansal N;Fan D;Hsu CY;Ordonez JD;Marcus GM;Go AS
心房颤动(AF)常见于慢性肾脏病(CKD)患者。然而，在慢性肾脏病患者中，房颤的发展对不良肾结局风险的长期影响尚不清楚。在这项研究中，我们确定了成人慢性肾脏病(CKD)患者发生房颤与终末期肾病(ESRD)风险的关系。我们研究了在2002年至2010年间在北加州凯撒永久医院登记的CKD(由CKD-EPI方程定义为持续性肾小球滤过率[EGFR]和lt；60ml/min/1.73m2)的成年人，他们之前没有ESRD或先前记录的房颤。房颤事件是通过初级医院出院诊断和/或两次或两次以上房颤门诊就诊来确定的。ESRD事件是从透析和肾移植的综合健康计划登记中确定的。在206,229名成年CKD患者中，有16,463人发生房颤。在平均5.1年±2.5年的随访期内，发生房颤后发生终末期再狭窄345例(每千人年74例)，而未发生房颤时终末期再狭窄6505例(/千人年，P<；0.001)。在调整了潜在的混杂因素后，发生房颤与ESRD发生率增加67%相关(危险比1.67，95%可信区间：1.46-1.91)。房颤事件与成年CKD患者发生ESRD的风险增加独立相关。需要进一步的研究来确定房颤导致进展为终末期肾病的风险更高的潜在的可改变的途径。
Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD). However, the long-term impact of development of AF on the risk of adverse renal outcomes in patients with CKD is unknown. In this study, we determined the association between incident AF and risk of end-stage renal disease (ESRD) among adults with CKD. We studied adults with CKD (defined as persistent glomerular filtration rate [eGFR] <60 ml/min/1.73 m2 by the CKD-EPI equation) enrolled in Kaiser Permanente Northern California who were identified between 2002–2010 and who did not have prior ESRD or previously documented AF. Incident AF was identified using primary hospital discharge diagnoses and/or two or more outpatient visits for AF. Incident ESRD was ascertained from a comprehensive health plan registry for dialysis and renal transplant. Among 206,229 adults with CKD, 16,463 developed incident AF. During a mean follow-up of 5.1± 2.5 years, there were 345 cases of ESRD that occurred after development of incident AF (74 per 1000 person-years) compared with 6505 cases of ESRD during periods without AF (64 per 1000 person-years, P<0.001). After adjustment for potential confounders, incident AF was associated with a 67% increase in rate of ESRD (hazard ratio 1.67, 95% confidence interval: 1.46–1.91). Incident AF is independently associated with increased risk of developing ESRD in adults with CKD. Further study is needed to identify potentially modifiable pathways through which AF leads to a higher risk of progression to ESRD.