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Relation of renal dysfunction with incident atrial fibrillation and cardiovascular morbidity and mortality: The PREVEND study.
Europace 2017; 19(12):1930-1936E

Abstract

Aims

Renal dysfunction is a risk factor for cardiovascular disease, including atrial fibrillation (AF) and mortality. However, the exact pathobiology linking different renal dysfunction measures, such as albumin excretion or glomerular filtration rate (GFR), to cardiovascular- and AF risk are unclear. In this study, we investigated the association of several renal function measures and incident AF, and whether the relation between renal measures and outcomes is modified by AF.

Methods and results

We examined 8265 individuals (age 49 ± 13 years, 50% women) included in the PREVEND study. We used albumin excretion (morning void and 24-h urine samples), serum creatinine, cystatin C, and Cystatin C-based, creatinine-based, and creatinine-cystatin C-based GFR as renal function measures; results: During a follow-up of 9.8 ± 2.3 years, 267 participants (3.2%) developed AF. In the multivariate-adjusted model, GFR, estimated by creatinine, cystatin C, or the combination was not associated with incident AF. However, increased albumin excretion was strongly associated with incident AF; urine albumin concentration and excretion (HRmorning void 1.10, P = 0.005 and HR24-hr collection 1.05, P = 0.033) and albumin creatinine ratio (HRmorning void 1.05, P = 0.010 and HR24-hr collection 1.06, P < 0.001). Interaction terms of incident AF and renal measures were not significant for incident cerebrovascular events, peripheral vascular events, ischemic heart disease, heart failure, and mortality.

Conclusion

In this community-based cohort, increased albumin excretion, and not GFR, was associated with incident AF, independent of established cardiovascular risk factors. Incidence of AF did not largely alter the association of renal dysfunction and cardiovascular outcomes.

Authors+Show Affiliations

Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28108549

Citation

Marcos, Ernaldo G., et al. "Relation of Renal Dysfunction With Incident Atrial Fibrillation and Cardiovascular Morbidity and Mortality: the PREVEND Study." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 19, no. 12, 2017, pp. 1930-1936.
Marcos EG, Geelhoed B, Van Der Harst P, et al. Relation of renal dysfunction with incident atrial fibrillation and cardiovascular morbidity and mortality: The PREVEND study. Europace. 2017;19(12):1930-1936.
Marcos, E. G., Geelhoed, B., Van Der Harst, P., Bakker, S. J. L., Gansevoort, R. T., Hillege, H. L., ... Rienstra, M. (2017). Relation of renal dysfunction with incident atrial fibrillation and cardiovascular morbidity and mortality: The PREVEND study. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 19(12), pp. 1930-1936. doi:10.1093/europace/euw373.
Marcos EG, et al. Relation of Renal Dysfunction With Incident Atrial Fibrillation and Cardiovascular Morbidity and Mortality: the PREVEND Study. Europace. 2017 Dec 1;19(12):1930-1936. PubMed PMID: 28108549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relation of renal dysfunction with incident atrial fibrillation and cardiovascular morbidity and mortality: The PREVEND study. AU - Marcos,Ernaldo G, AU - Geelhoed,Bastiaan, AU - Van Der Harst,Pim, AU - Bakker,Stefan J L, AU - Gansevoort,Ron T, AU - Hillege,Hans L, AU - Van Gelder,Isabelle C, AU - Rienstra,Michiel, PY - 2016/09/07/received PY - 2016/10/24/accepted PY - 2017/1/22/pubmed PY - 2018/7/31/medline PY - 2017/1/22/entrez KW - Atrial fibrillation KW - Epidemiology KW - Mortality KW - Renal function KW - Risk factor SP - 1930 EP - 1936 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 19 IS - 12 N2 - Aims: Renal dysfunction is a risk factor for cardiovascular disease, including atrial fibrillation (AF) and mortality. However, the exact pathobiology linking different renal dysfunction measures, such as albumin excretion or glomerular filtration rate (GFR), to cardiovascular- and AF risk are unclear. In this study, we investigated the association of several renal function measures and incident AF, and whether the relation between renal measures and outcomes is modified by AF. Methods and results: We examined 8265 individuals (age 49 ± 13 years, 50% women) included in the PREVEND study. We used albumin excretion (morning void and 24-h urine samples), serum creatinine, cystatin C, and Cystatin C-based, creatinine-based, and creatinine-cystatin C-based GFR as renal function measures; results: During a follow-up of 9.8 ± 2.3 years, 267 participants (3.2%) developed AF. In the multivariate-adjusted model, GFR, estimated by creatinine, cystatin C, or the combination was not associated with incident AF. However, increased albumin excretion was strongly associated with incident AF; urine albumin concentration and excretion (HRmorning void 1.10, P = 0.005 and HR24-hr collection 1.05, P = 0.033) and albumin creatinine ratio (HRmorning void 1.05, P = 0.010 and HR24-hr collection 1.06, P < 0.001). Interaction terms of incident AF and renal measures were not significant for incident cerebrovascular events, peripheral vascular events, ischemic heart disease, heart failure, and mortality. Conclusion: In this community-based cohort, increased albumin excretion, and not GFR, was associated with incident AF, independent of established cardiovascular risk factors. Incidence of AF did not largely alter the association of renal dysfunction and cardiovascular outcomes. SN - 1532-2092 UR - https://www.unboundmedicine.com/medline/citation/28108549/Relation_of_renal_dysfunction_with_incident_atrial_fibrillation_and_cardiovascular_morbidity_and_mortality:_The_PREVEND_study_ L2 - https://academic.oup.com/europace/article-lookup/doi/10.1093/europace/euw373 DB - PRIME DP - Unbound Medicine ER -