Early chronic kidney disease associated with atrial fibrillation

Emma Hitt

August 19, 2010

Winston-Salem, NC - Early-stage chronic kidney disease (CKD) is associated with increased risk of atrial fibrillation (AF), according to new research [1].

The findings from the Chronic Renal Insufficiency Cohort (CRIC), led by Dr Elsayed Z Soliman (Wake Forest Baptist Medical Center, Winston-Salem, NC) were published in the June 2010 issue of the American Heart Journal.

The link between later stages of CKD and AF has been established, but data regarding the early stages of CKD are limited. In the current analysis, Soliman and colleagues analyzed data from 3267 adult patients with CKD who had not received dialysis and determined by 12-lead electrocardiogram and questioning whether they had AF.

Among the participants, the mean glomerular filtration rate (GFR) was 43.6 mL/min/1.73 m2, and approximately 55% of the study population had a GFR <45 mL/min/1.73 m2, indicating a mild to moderate level of CKD in most participants. In addition, 18% had AF, similar to the prevalence reported among patients with end-stage renal disease and two- to threefold greater than that observed in the general population.

Variables associated with an increased risk of AF in this setting were age (27% increased risk for every 11-year increase, p<0.0001); female gender (20% decreased risk, p=0.0303); prior vs never smoking (34% increased risk, p=0.0081); history of heart failure (more than a threefold increased risk, p<0.001); and a history of cardiovascular disease (nearly a twofold increased risk; p<0.0001).

By contrast, other risk factors associated with AF in the general population, including race/ethnicity, hypertension, diabetes, body-mass index, physical activity, education, hs-CRP, total cholesterol, and alcohol intake, were not present in this CKD population, suggesting the need for the development of a distinct set of criteria for predicting AF in patients with CKD.

"More than 25 million US adults have chronic kidney disease, and most of them are not on dialysis," Soliman stated in a written release [2]. "Understanding the prevalence and risk factors of AF in this group of patients has important public-health, epidemiologic, and clinical implications."

According to Soliman, the high rate of AF seen in patients with early stages of CKD suggests that the processes that influence the development of AF may occur early in the course of CKD. "This greater prevalence also emphasizes the importance of more closely monitoring the health conditions of this set of patients," he added.

The researchers speculate that a potential mechanism for a higher prevalence of AF in early stages of CKD could be related to inflammation. "Elevated levels of inflammatory markers have been reported in CKD even in its early stages, inflammatory markers predict progression of kidney dysfunction, and inflammation plays a significant role in the pathogenesis of AF," they suggest. One inflammatory marker, hs-CRP, was not found to be elevated, although other inflammatory markers may be involved.

The study was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases . The authors report no relevant financial conflicts.


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