Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function.

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Tytuł:: Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function.
Autorzy:: Molnar AO; Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Eddeen AB; Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
Ducharme R; Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
Garg AX; Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.; Epidemiology, Western University, London, Ontario, Canada.; Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
Harel Z; Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
McCallum MK; Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
Perl J; Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Wald R; Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Zimmerman D; Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada.
Sood MM; Institute for Clinical Evaluative Sciences, London, Ontario, Canada .; Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada.; Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Źródło:: Journal of the American Heart Association [J Am Heart Assoc] 2017 Jul 06; Vol. 6 (7). Date of Electronic Publication: 2017 Jul 06.
Typ publikacji:: Comparative Study; Journal Article
Język:: English
Imprint Name(s):: Original Publication: Oxford : Wiley-Blackwell
MeSH Terms:: Glomerular Filtration Rate*
Albuminuria/*epidemiology
Atrial Fibrillation/*epidemiology
Kidney/*physiopathology
Kidney Diseases/*epidemiology
Adult ; Aged ; Albuminuria/diagnosis ; Albuminuria/physiopathology ; Albuminuria/urine ; Atrial Fibrillation/diagnosis ; Biomarkers/urine ; Chi-Square Distribution ; Creatinine/urine ; Disease Progression ; Female ; Humans ; Incidence ; Kidney Diseases/diagnosis ; Kidney Diseases/physiopathology ; Kidney Diseases/urine ; Male ; Middle Aged ; Multivariate Analysis ; Ontario/epidemiology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors
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Contributed Indexing:: Keywords: atrial fibrillation; chronic kidney disease; risk factor
Substance Nomenclature:: 0 (Biomarkers)
AYI8EX34EU (Creatinine)
Entry Date(s):: Date Created: 20170708 Date Completed: 20180516 Latest Revision: 20240326
Update Code:: 20240326
PubMed Central ID:: PMC5586292
DOI:: 10.1161/JAHA.117.005685
PMID:: 28684642
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Background: Early evidence suggests proteinuria is independently associated with incident atrial fibrillation (AF). We sought to investigate whether the association of proteinuria with incident AF is altered by kidney function.
Methods and Results: Retrospective cohort study using administrative healthcare databases in Ontario, Canada (2002-2015). A total of 736 666 patients aged ≥40 years not receiving dialysis and with no previous history of AF were included. Proteinuria was defined using the urine albumin-to-creatinine ratio (ACR) and kidney function by the estimated glomerular filtration rate (eGFR). The primary outcome was time to AF. Cox proportional models were used to determine the hazard ratio for AF censored for death, dialysis, kidney transplant, or end of follow-up. Fine and Grey models were used to determine the subdistribution hazard ratio for AF, with death as a competing event. Median follow-up was 6 years and 44 809 patients developed AF. In adjusted models, ACR and eGFR were associated with AF ( P <0.0001). The association of proteinuria with AF differed based on kidney function (ACR × eGFR interaction, P <0.0001). Overt proteinuria (ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact (eGFR, 120) versus reduced (eGFR, 30) kidney function (adjusted hazard ratios, 4.5 [95% CI, 4.0-5.1] and 2.6 [95% CI, 2.4-2.8], respectively; referent ACR 0 and eGFR 120). Results were similar in competing risk analyses.
Conclusions: Proteinuria increases the risk of incident AF markedly in patients with intact kidney function compared with those with decreased kidney function. Screening and preventative strategies should consider proteinuria as an independent risk factor for AF.
(© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)

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