Clinical InvestigationElectrophysiologyClose bidirectional relationship between chronic kidney disease and atrial fibrillation: The Niigata preventive medicine study
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)
- et al.
A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study
Am J Med
(2002) - et al.
Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients
Am J Kidney Dis
(2005) - et al.
Insulin resistance and hyperinsulinemia are already present in patients with incipient renal disease
Kidney Int
(1998) - et al.
Cardiovascular disease in patients with chronic kidney disease: getting to the heart of the matter
Am J Kidney Dis
(2001) - et al.
Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study
Am J Kidney Dis
(2004) - et al.
Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation
J Am Coll Cardiol
(2000) - et al.
Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis
J Am Coll Cardiol
(2005) - et al.
Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study
J Am Coll Cardiol
(2005) - et al.
Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients
Am J Kidney Dis
(1998) - et al.
A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease
Am J Kidney Dis
(2003)