Introduction Atrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD), however, the association between AF and incident ESRD has not been examined in the general United States population. Methods A total of 24,953 participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified at baseline (2003-2007) from electrocardiogram data and self-reported history. Incident cases of ESRD were identified through linkage with the United States Renal Data System. Cox proportional-hazards regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between AF and incident ESRD. Results A total of 2,155 (8.6%) participants had AF at baseline. Over a median follow-up of 7.4 years, 295 (1.2%) persons developed ESRD. In a model adjusted for demographics and potential confounders, AF was associated with an increased risk of incident ESRD (HR = 1.51, 95% CI = 1.08, 2.11). The association between AF and ESRD became non-significant after further adjustment for CKD markers (eGFR < 60 mL/min/1.73 m2 and urine albumin-to-creatinine ratio ≥ 30 mg/dL) (HR = 1.24, 95% CI = 0.89, 1.73). Conclusion AF is associated with an increased risk of ESRD in the general United States population and this association potentially is explained by underlying CKD.
Bibliographical noteFunding Information:
This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org . Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation . Amgen played no role in the study design, collection, analysis and interpretation of data for this manuscript.
© 2015 Elsevier Ireland Ltd. All rights reserved.
- Atrial fibrillation
- Renal disease