Elsevier

American Heart Journal

Volume 158, Issue 4, October 2009, Pages 629-636
American Heart Journal

Clinical Investigation
Electrophysiology
Close bidirectional relationship between chronic kidney disease and atrial fibrillation: The Niigata preventive medicine study

https://doi.org/10.1016/j.ahj.2009.06.031Get rights and content

Background

Atrial fibrillation (AF) and chronic kidney disease share risk factors and pathophysiologic mechanisms, suggesting that two conditions have close relationships.

Methods

This is a prospective community-based observational cohort study including 235,818 subjects based upon a voluntary annual health check-up program in Japan. We studied the association of kidney dysfunction at entry with subsequent new-onset AF and the association of AF at entry with the development of kidney disease.

Results

During a follow-up of 5.9 ± 2.4 years, AF developed in 2947 subjects (1.3%). Baseline serum creatinine and estimated glomerular filtration rate (GFR) were associated with risk of subsequent AF. The HRs (95% CI) for AF were 1.32 (1.08-1.62) and 1.57 (0.89-2.77) for GFR 30 to 59 and <30 mL/min per 1.73 m2, respectively. The effect of kidney disease on risk of new-onset AF remained significant in subjects without treated hypertension or diabetes. During the follow-up, 7791 subjects (3.3%) developed kidney dysfunction (GFR <60 mL/min per 1.73 m2), and 11 307 subjects (4.9%) developed proteinuria. Atrial fibrillation at entry was associated with development of kidney dysfunction (HRs [95% CI], 1.77 [1.50-2.10]) and proteinuria (HR [95% CI], 2.20 [1.92-2.52]). The association persisted in subjects without treated hypertension or diabetes.

Conclusions

Kidney dysfunction increased the risk of new onset of AF, and AF increased the risk of development of kidney disease. This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis.

Section snippets

Study subjects

This community-based, observational cohort study was based on a program of voluntary annual health examinations in the Niigata Association for Comprehensive Health Promotion and Research, Niigata, Japan.19 In the prefecture, annual health examinations supported by administration are available to residents ≥20 years of age. The population of the prefecture is about 2 400 000, and about 250 000 residents (~50% of subjects) receive the examination during one year. The annual examination consists

Association of kidney disease with development of AF

The entire cohort, which was analyzed for the association of kidney disease with development of AF, included 223,877 subjects after elimination of the subjects with exclusions (Figure 1). The mean age was 60.9 ± 11.7 years and 68% of subjects were women (Table I). The mean serum creatinine was 0.6 ± 0.2 mg/dL at the baseline and the mean estimated GFR was 102.6 ± 25.1 mL/min per 1.73 m2. Subjects with baseline GFR 30-59 mL/min per 1.73 m2 and GFR <30 mL/min per 1.73 m2 were identified in 1.7%

Discussion

In this general population of adults, we have shown a close association between AF and kidney disease: kidney disease was associated with the development of AF and AF was associated with the development of kidney disease. Although hypertension and diabetes are known as strong risk factors for subsequent AF and kidney disease,17, 18, 20, 21 both associations remained significant in subjects without hypertension or diabetes.

Associations have previously been described between AF and chronic kidney

Conclusions

We found that there is an association between kidney disease and AF, even in the absence of hypertension and diabetes. We suggest that disrupted multiple signaling pathways may be critical for the pathogenesis of both diseases and, potentially, their interaction. Chronic kidney disease and AF are associated with increased incidence of cardiovascular events and high mortality, and our findings further propose the importance of management of these diseases to prevent subsequent events and to

References (53)

  • VermaA. et al.

    Effect of rosuvastatin on C-reactive protein and renal function in patients with chronic kidney disease

    Am J Cardiol

    (2005)
  • IssacT.T. et al.

    Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data

    J Am Coll Cardiol

    (2007)
  • GoA.S. et al.

    Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study

    JAMA

    (2001)
  • Lloyd-JonesD.M. et al.

    Lifetime risk for development of atrial fibrillation: the Framingham Heart Study

    Circulation

    (2004)
  • WolfP.A. et al.

    Atrial fibrillation as an independent risk factor for stroke: the Framingham Study

    Stroke

    (1991)
  • BenjaminE.J. et al.

    Impact of atrial fibrillation on the risk of death: the Framingham Heart Study

    Circulation

    (1998)
  • FribergJ. et al.

    Rising rates of hospital admissions for atrial fibrillation

    Epidemiology

    (2003)
  • WattigneyW.A. et al.

    Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention

    Circulation

    (2003)
  • GilbertsonD.T. et al.

    Projecting the number of patients with end-stage renal disease in the United States to the year 2015

    J Am Soc Nephrol

    (2005)
  • NakaiS. et al.

    Overview of regular dialysis treatment in Japan (as of 31 December 2005)

    Ther Apher Dial

    (2007)
  • GoA.S. et al.

    Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization

    N Engl J Med

    (2004)
  • ElsayedE.F. et al.

    Cardiovascular disease and subsequent kidney disease

    Arch Intern Med

    (2007)
  • AnsariN. et al.

    Symptomatic atrial arrhythmias in hemodialysis patients

    Ren Fail

    (2001)
  • FabbianF. et al.

    Clinical characteristics associated to atrial fibrillation in chronic hemodialysis patients

    Clin Nephrol

    (2000)
  • AlbahraniM.J. et al.

    Postcardiac surgery complications: association of acute renal dysfunction and atrial fibrillation

    Anesth Analg

    (2003)
  • NisanogluV. et al.

    Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis

    Thorac Cardiovasc Surg

    (2007)
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