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Eur J Prev Cardiol. 2017 Jan;24(2):213-222. doi: 10.1177/2047487316676132. Epub 2016 Oct 27.

Estimated glomerular filtration rate within the normal or mildly impaired range and incident non-valvular atrial fibrillation: Results from a population-based cohort study.

Author information

1
1 Cardiology Department, Rabin Medical Center, Israel; affiliated to Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
2
2 Cardiology Department, Soroka medical center, Israel; affiliated to Ben Gurion University, Beer Sheva, Israel.
3
3 Clalit Health Research Institute, Israel.

Abstract

Background Lower estimated glomerular filtration rate, in particular in the significant renal impairment range (estimated glomerular filtration rate <60 ml/min/1.73 m2), is associated with incident atrial fibrillation. This association is less established within the normal or mildly impaired estimated glomerular filtration rate range. Methods Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate formula, we identified ambulatory adults (>22 years old) without rheumatic heart disease or prosthetic valves and with 60 ml/min/1.73 m2<estimated glomerular filtration rate<130 ml/min/1.73 m2 in their index visit, for incident, newly-diagnosed atrial fibrillation. We analyzed cohorts with and without prior cardiovascular disease. Results Over a mean follow-up of 104 months and >10 m patient-years of follow-up (∼75% <60 years old, ∼57% females), >65,000 individuals had ≥1 atrial fibrillation event (incident atrial fibrillation rate 5.1% and 5.8% excluding or including prior cardiovascular disease, or 49 and 55 per 10,000 patient-years, respectively). In both cohorts, individuals with versus without incident atrial fibrillation had lower mean estimated glomerular filtration rate (∼83 versus 95 ml/min/1.73 m2). Adjusting for age, gender, hypertension, and diabetes mellitus, overall a 10 ml/min/1.73 m2 decrease in estimated glomerular filtration rate was independently associated with a mean increase in incident atrial fibrillation of 1.5% and 2.4% in the cohorts excluding or including prior cardiovascular disease, respectively ( p < 0.001 for both). However, a graded association between lower estimated glomerular filtration rate and atrial fibrillation was observed in the 90-130 ml/min/1.73 m2 range, whereas a blunted association was observed in the 60-90 ml/min/1.73 m2 range. Conclusion Within the 60 ml/min/1.73 m2 < estimated glomerular filtration rate < 130 ml/min/1.73 m2 range, lower estimated glomerular filtration rate is independently associated with incident non-valvular atrial fibrillation in adults without prior atrial fibrillation, mainly attributed to a graded association within the 90-130 ml/min/1.73 m2 range.

KEYWORDS:

Kidney function; atrial fibrillation; creatinine; glomerular filtration rate; non-valvular

PMID:
27798368
DOI:
10.1177/2047487316676132
[Indexed for MEDLINE]

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