Abstract 9724: Impaired Renal Function is Associated with an Increased Risk for Incident Atrial Fibrillation
Introduction: The prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD) are rapidly rising. Few prospective studies have explored the association between renal function and risk of incident atrial fibrillation (AF) among an apparently healthy population.
Methods: A total of 24,746 women participating in the Women's Health Study who were free of cardiovascular disease (CVD), AF and provided a blood sample at baseline were prospectively followed-up for incident AF from 1993-2010. AF was confirmed by medical chart review. Renal function was measured as estimated glomerular filtration rate (eGFR) calculated from baseline creatinine using the Chronic Kidney Disease - Epidemiology (CKD-EPI) equation. Cox models were used to estimate hazard ratios (HR) and 95%CI for incident AF across eGFR categories (<60, 60-74.9, 75-89, and > 90 ml/min/1.73 m2) controlling for AF risk factors. In a secondary analysis, eGFR was dichotomized at 60 ml/min/1.73 m2 based on a GFR definition of chronic kidney disease. Multivariable models controlled for age, systolic blood pressure, body mass index, total cholesterol, C reactive protein concentration, antihypertensive treatment, alcohol, exercise, smoking, diabetes, and postmenopausal hormone use.
Results: Of the total 24 746 women, 15 374 (62.1%) had an eGFR ≥ 90 ml/min/1.73 m2, 5901 (23.8%) had an eGFR 75-89 ml/min/1.73 m2, 2463 (10.0%) had an eGFR 60-74 ml/min/1.73 m2 and 1008 (4.1%) had an eGFR <60 ml/min/1.73 m2. During a median 15.4 years of follow-up, 786 incident AF events occurred. The age adjusted incidence rate per 1000 person years across eGFR categories (<60, 60-74.9, 75-89, and > 90 ml/min/1.73 m2) was 2.61, 2.01, 2.21, and 2.15. The multivariable-adjusted HR for eGFR categories were 1.36 (95% CI, 1.00-1.84), 0.90 (95% CI, 0.71-1.14), 0.99 (95% CI, 0.84-1.18) and 1.00 (P for trend, 0.48). Among women with eGFR < 60 compared to those with ≥ 60 ml/min/1.73 m2, the multivariable adjusted HR was 1.39 (95% CI, 1.04-1.86, p value 0.03).
Conclusions: In this large prospective cohort of apparently healthy women, we observed no increase in risk of incident AF among women with less severe impairment of renal function. However, there was a significant increase in AF risk observed at a threshold GFR of <60 ml/min/1.73 m2.
- © 2011 by American Heart Association, Inc.