Higher Risk of AF With Kidney Disease

June 10, 2011

June 9, 2011 (New York, New York) — Individuals with impaired kidney function and those with albuminuria are at a significantly increased risk of developing atrial fibrillation, according to the results of a new study [1].

The new data, from an analysis of the Atherosclerosis Risk in Communities (ARIC) study, "suggest that interventions aimed at preventing and treating chronic kidney disease could also contribute to reduce the burden of atrial fibrillation," according to Dr Alvaro Alonso (University of Minnesota, Minneapolis) and colleagues in a report published online June 6, 2011 in Circulation.

Previous studies have shown that patients with end-stage renal disease on hemodialysis have a significantly elevated risk of developing atrial fibrillation, but past studies evaluating the association between kidney function and atrial fibrillation have been conflicting, note the authors. In this analysis, researchers estimated the cystatin-C-based glomerular filtration rate (eGFRcys) and measured the albumin-to-creatinine ratio (ACR) in more than 10 000 men and women followed for a median of 10 years.

Compared with individuals with an eGFR > 90 mL/min/1.732 m, those with impaired kidney function had a significantly elevated risk of developing atrial fibrillation (hazard ratio 1.28, 1.64, and 3.18 for those with an eGFRcys 60–89, 30–59, and 15–29 mL/min/1.73m2, respectively; p<0.0001). For those with albuminuria, there was a threefold higher risk of developing atrial fibrillation for those with an ACR >300 mg/g and a twofold higher risk for those with an ACR between 30 and 299 mg/g when compared with those who had an ACR <30 mg/g.

The largest risk of atrial fibrillation was observed among individuals with both a low eGFRcys and an ACR >300 mg/g. These individuals had a 13-fold higher risk of atrial fibrillation compared those who had an ACR <30 mg/g and an eGFRcys >90 mL/min/1.73m2.

"Given the growing burden of chronic kidney disease in the general population and the potential for its prevention, future studies should focus on understanding the specific mechanisms underlying this association," write Alonso and colleagues. "Furthermore, strategies for the prevention of AF will have to consider chronic kidney disease as a preventable risk factor for AF in addition to other well-established risk factors."

Alonso reports funding from the National Institutes of Health.