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eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study.
Clin J Am Soc Nephrol 2017; 12(9):1386-1398CJ

Abstract

BACKGROUND AND OBJECTIVES

The incidence of atrial fibrillation is high in ESRD, but limited data are available on the incidence of atrial fibrillation across a broad range of kidney function. Thus, we examined the association of eGFR and urine albumin-to-creatinine ratio with risk of incident atrial fibrillation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We meta-analyzed three prospective cohorts: the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Cox regression models were performed examining the association of eGFR and urine albumin-to-creatinine ratio with incident atrial fibrillation adjusting for demographics and comorbidity. In additional analyses, we adjusted for measures of subclinical cardiovascular disease (by electrocardiogram and cardiac imaging) and interim heart failure and myocardial infarction events.

RESULTS

In the meta-analyzed study population of 16,769 participants without prevalent atrial fibrillation, across categories of decreasing eGFR (eGFR>90 [reference], 60-89, 45-59, 30-44, and <30 ml/min per 1.73 m2), there was a stepwise increase in the adjusted risk of incident atrial fibrillation: hazard ratios (95% confidence intervals) were 1.00, 1.09 (0.97 to 1.24), 1.17 (1.00 to 1.38), 1.59 (1.28 to 1.98), and 2.03 (1.40 to 2.96), respectively. There was a stepwise increase in the adjusted risk of incident atrial fibrillation across categories of increasing urine albumin-to-creatinine ratio (urine albumin-to-creatinine ratio <15 [reference], 15-29, 30-299, and ≥300 mg/g): hazard ratios (95% confidence intervals) were 1.00, 1.04 (0.83 to 1.30), 1.47 (1.20 to 1.79), and 1.76 (1.18 to 2.62), respectively. The associations were consistent after adjustment for subclinical cardiovascular disease measures and interim heart failure and myocardial infarction events.

CONCLUSIONS

In this meta-analysis of three cohorts, reduced eGFR and elevated urine albumin-to-creatinine ratio were significantly associated with greater risk of incident atrial fibrillation, highlighting the need for further studies to understand mechanisms linking kidney disease with atrial fibrillation.

Authors+Show Affiliations

Division of Nephrology, Kidney Research Institute, nbansal@uw.edu.Division of Nephrology, Kidney Research Institute.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.Department of Medicine, Boston University School of Medicine and School of Public Health, Boston, Massachusetts.Division of Nephrology, Kidney Research Institute. Veterans Affairs Puget Sound Health Care System, Seattle, Washington.Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania.Division of Nephrology, Kidney Research Institute.Division of Nephrology, Kidney Research Institute.Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.Division of Nephrology, Kidney Research Institute.Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and.Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California.Division of Cardiology. Cardiovascular Health Research Unit, and.Division of Nephrology, Kidney Research Institute. Veterans Affairs Puget Sound Health Care System, Seattle, Washington.Cardiovascular Health Research Unit, and. Department of Epidemiology, University of Washington, Seattle, Washington.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28798221

Citation

Bansal, Nisha, et al. "EGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: a Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 9, 2017, pp. 1386-1398.
Bansal N, Zelnick LR, Alonso A, et al. EGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clin J Am Soc Nephrol. 2017;12(9):1386-1398.
Bansal, N., Zelnick, L. R., Alonso, A., Benjamin, E. J., de Boer, I. H., Deo, R., ... Heckbert, S. R. (2017). EGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clinical Journal of the American Society of Nephrology : CJASN, 12(9), pp. 1386-1398. doi:10.2215/CJN.01860217.
Bansal N, et al. EGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: a Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1386-1398. PubMed PMID: 28798221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. AU - Bansal,Nisha, AU - Zelnick,Leila R, AU - Alonso,Alvaro, AU - Benjamin,Emelia J, AU - de Boer,Ian H, AU - Deo,Rajat, AU - Katz,Ronit, AU - Kestenbaum,Bryan, AU - Mathew,Jehu, AU - Robinson-Cohen,Cassianne, AU - Sarnak,Mark J, AU - Shlipak,Michael G, AU - Sotoodehnia,Nona, AU - Young,Bessie, AU - Heckbert,Susan R, Y1 - 2017/08/10/ PY - 2017/02/16/received PY - 2017/05/15/accepted PY - 2017/8/12/pubmed PY - 2018/5/22/medline PY - 2017/8/12/entrez KW - albuminuria KW - cardiovascular disease KW - chronic kidney disease SP - 1386 EP - 1398 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 9 N2 - BACKGROUND AND OBJECTIVES: The incidence of atrial fibrillation is high in ESRD, but limited data are available on the incidence of atrial fibrillation across a broad range of kidney function. Thus, we examined the association of eGFR and urine albumin-to-creatinine ratio with risk of incident atrial fibrillation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We meta-analyzed three prospective cohorts: the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Cox regression models were performed examining the association of eGFR and urine albumin-to-creatinine ratio with incident atrial fibrillation adjusting for demographics and comorbidity. In additional analyses, we adjusted for measures of subclinical cardiovascular disease (by electrocardiogram and cardiac imaging) and interim heart failure and myocardial infarction events. RESULTS: In the meta-analyzed study population of 16,769 participants without prevalent atrial fibrillation, across categories of decreasing eGFR (eGFR>90 [reference], 60-89, 45-59, 30-44, and <30 ml/min per 1.73 m2), there was a stepwise increase in the adjusted risk of incident atrial fibrillation: hazard ratios (95% confidence intervals) were 1.00, 1.09 (0.97 to 1.24), 1.17 (1.00 to 1.38), 1.59 (1.28 to 1.98), and 2.03 (1.40 to 2.96), respectively. There was a stepwise increase in the adjusted risk of incident atrial fibrillation across categories of increasing urine albumin-to-creatinine ratio (urine albumin-to-creatinine ratio <15 [reference], 15-29, 30-299, and ≥300 mg/g): hazard ratios (95% confidence intervals) were 1.00, 1.04 (0.83 to 1.30), 1.47 (1.20 to 1.79), and 1.76 (1.18 to 2.62), respectively. The associations were consistent after adjustment for subclinical cardiovascular disease measures and interim heart failure and myocardial infarction events. CONCLUSIONS: In this meta-analysis of three cohorts, reduced eGFR and elevated urine albumin-to-creatinine ratio were significantly associated with greater risk of incident atrial fibrillation, highlighting the need for further studies to understand mechanisms linking kidney disease with atrial fibrillation. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28798221/eGFR_and_Albuminuria_in_Relation_to_Risk_of_Incident_Atrial_Fibrillation:_A_Meta_Analysis_of_the_Jackson_Heart_Study_the_Multi_Ethnic_Study_of_Atherosclerosis_and_the_Cardiovascular_Health_Study_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=28798221 DB - PRIME DP - Unbound Medicine ER -