Incident atrial fibrillation and risk of death in adults with chronic kidney disease.
Incident atrial fibrillation and risk of death in adults with chronic kidney disease.
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DOI：
10.1161/jaha.114.001303
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发表时间：
2014-10-20
影响因子：
5.4
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;Go AS
心房颤动 (AF) 经常发生在慢性肾病 (CKD) 患者中；然而，AF 的发展对 CKD 患者死亡风险的长期影响尚不清楚。我们研究了 2002 年至 2010 年间在北加州 Kaiser Permanente 入组且之前没有 AF 记录的 CKD 成人（根据慢性肾脏病流行病学协作方程，肾小球滤过率 <60 mL/min 每 1.73 m2）。 AF 事件是通过初次出院诊断或≥2 次 AF 门诊就诊来确定的。死亡情况是通过健康计划管理数据库、社会保障管理局生命状态文件和加州死亡证明登记处综合确定的。协变量包括人口统计学、合并症、动态血压、实验室值（血红蛋白、蛋白尿）和纵向药物使用。在 81088 名患有 CKD 的成年人中，6269 名（7.7%）在平均 4.8±2.7 年的随访期间出现了临床上公认的房颤事件。房颤发生后有 2388 例死亡（每 1000 人年 145 例），而无房颤期间死亡人数为 18 865 例（每 1000 人年 51 例，P<0.001）。调整潜在混杂因素后，房颤事件与相对死亡率增加 66% 相关（调整后的风险比为 1.66，95% CI 1.57 至 1.77）。 AF 事件与 CKD 成人死亡风险增加独立相关。需要进一步研究来了解 CKD 与 AF 相关的机制，并确定潜在的可改变的危险因素，以减轻 AF 的负担以及该高危人群随后的死亡风险。
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 death among patients with CKD is unknown. We studied adults with CKD (glomerular filtration rate <60 mL/min per 1.73 m2 by the Chronic Kidney Disease Epidemiology Collaboration equation) identified between 2002 and 2010 who were enrolled in Kaiser Permanente Northern California and had no previously documented AF. Incident AF was identified using primary hospital discharge diagnoses or ≥2 outpatient visits for AF. Death was comprehensively ascertained from health plan administrative databases, Social Security Administration vital status files, and the California death certificate registry. Covariates included demographics, comorbidity, ambulatory blood pressure, laboratory values (hemoglobin, proteinuria), and longitudinal medication use. Among 81 088 adults with CKD, 6269 (7.7%) developed clinically recognized incident AF during a mean follow‐up of 4.8±2.7 years. There were 2388 cases of death that occurred after incident AF (145 per 1000 person‐years) compared with 18 865 cases of death during periods without AF (51 per 1000 person‐years, P<0.001). After adjustment for potential confounders, incident AF was associated with a 66% increase in relative rate of death (adjusted hazard ratio 1.66, 95% CI 1.57 to 1.77). Incident AF is independently associated with an increased risk of death in adults with CKD. Further study is needed to understand the mechanisms by which CKD is associated with AF and to identify potentially modifiable risk factors to decrease the burden of AF and subsequent risk of death in this high‐risk population.