Chronic kidney disease (CKD) is a potential independent risk factor for atrial fibrillation (AF). It remains unclear whether anemia is synergistically associated with increased risk of AF onset in subjects with CKD. We evaluated the association of kidney function, hemoglobin (Hb), and their combination with new-onset AF in a population-based cohort study. We conducted a 15-year prospective cohort study of 132,250 Japanese subjects aged 40 to 79 years who participated in annual health checkups from 1993. Kaplan-Meier survival analysis was used to compare freedom from new-onset AF between groups classified by estimated glomerular filtration rate grade, Hb grade, and their combination. Cox proportional hazard model analysis was used to estimate hazard ratios (HRs) for new-onset AF. During a 13.8-year mean follow-up period, 1,232 (0.93%) subjects with new-onset AF were identified. Lower estimated glomerular filtration rate and lower Hb grades were significantly associated with a higher incidence of new-onset AF. Multivariate HRs and 95% confidence intervals (CIs) of new-onset AF were 1.38 (1.21 to 1.56) for mild CKD group, 2.56 (2.09 to 3.13) for CKD group, and 1.50 (1.24 to 1.83) for anemia group. Borderline Hb level was not significantly associated with increased risk for new-onset AF (HR 1.07, CI 0.91 to 1.25, p = 0.4284). In the model with interaction term between CKD and anemia, the risk was significantly higher (p = 0.0343 for the interaction) than that predicted by each factor independently. In conclusion, decreased kidney function and lower Hb level are associated with increased risk for new-onset AF, especially when both are present.
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References
-
Chronic kidney disease and prevalent atrial fibrillation: the Chronic Renal Insufficiency Cohort (CRIC).Am Heart J. 2010; 159: 1102-1107
-
Prevalence of atrial fibrillation and its predictors in nondialysis patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 173-181
-
Chronic kidney disease: effects on the cardiovascular system.Circulation. 2007; 116: 85-97
-
Relation of atrial fibrillation to glomerular filtration rate.Am J Cardiol. 2008; 102: 1056-1059
-
Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata Preventive Medicine Study.Am Heart J. 2009; 158: 629-636
-
Chronic kidney disease as an independent risk factor for new-onset atrial fibrillation in hypertensive patients.J Hypertens. 2010; 28: 1738-1744
-
The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease.Am J Kidney Dis. 1996; 28: 53-61
-
Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction.J Am Coll Cardiol. 2001; 38: 955-962
-
Atrial fibrillation and heart rate independently correlate to microalbuminuria in hypertensive patients.Eur Heart J. 2009; 30: 1364-1371
-
Relation of kidney function and albuminuria with atrial fibrillation (from the Heart and Soul Study).Am J Cardiol. 2009; 104: 1551-1555
-
A multicenter risk index for atrial fibrillation after cardiac surgery.JAMA. 2004; 291: 1720-1729
-
Concomitant chronic kidney disease increases the recurrence of atrial fibrillation after catheter ablation of atrial fibrillation: a mid-term follow-up.Heart Rhythm. 2011; 8: 335-341
-
Renal function after catheter ablation of atrial fibrillation.Circulation. 2011; 124: 2380-2387
-
Clinical characteristics associated to atrial fibrillation in chronic hemodialysis patients.Clin Nephrol. 2000; 54: 234-239
-
Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation.J Am Coll Cardiol. 2000; 35: 1669-1677
-
Renin-angiotensin system gene polymorphisms and atrial fibrillation.Circulation. 2004; 109: 1640-1646
-
Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation.J Am Coll Cardiol. 2003; 41: 2197-2204
-
Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based Atherosclerosis Risk in Communities (ARIC) study.J Am Soc Nephrol. 2003; 14: 2919-2925
-
Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study.Kidney Int. 2003; 64: 610-615
-
Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease.J Am Soc Nephrol. 2005; 16: 3403-3410
-
Anaemia in heart failure: a common interaction with renal insufficiency called the cardio-renal anaemia syndrome.Int J Clin Pract. 2008; 62: 281-286
-
Anemia as a risk factor for cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study.J Am Coll Cardiol. 2002; 40: 27-33
-
Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients.Clin Exp Nephrol. 2010; 14: 28-35
Article info
Publication history
Published online: November 11, 2014
Accepted: October 28, 2014
Received in revised form: October 28, 2014
Received: August 8, 2014
Footnotes
See page 332 for disclosure information.
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
