Chronic kidney disease as an independent risk factor for new-onset atrial fibrillation in hypertensive patients.
OBJECTIVE
Chronic kidney disease (CKD) has recently been recognized to be a powerful predictor of cardiovascular morbidity and mortality. Atrial fibrillation (AF), which is a common arrhythmia in hypertensives, is associated with increased risks of cardiovascular events and death. However, the association between CKD and the onset of AF has not been fully elucidated. The present study assessed the hypothesis that CKD may influence the onset of AF in hypertensives.


METHODS
A total of 1118 hypertensive patients (mean age, 63 years) without previous paroxysmal AF, heart failure, myocardial infarction, or valvular disease were enrolled. CKD was defined as decreased glomerular filtration rate (<60 ml/min per 1.73 m) and/or the presence of proteinuria (>or=1+).


RESULTS
During follow-up periods (mean, 4.5 years), 57 cases of new-onset AF were found (1.1% per year). Kaplan-Meier curves revealed that the cumulative AF event-free rate was decreased in the CKD group (log-rank test P < 0.001). By univariate Cox regression analysis, age, smoking, left atrial dimension, left ventricular mass index, and the presence of CKD were significantly associated with the occurrence of AF. Among these possible predictors, CKD (hazard ratio 2.18, P = 0.009) was an independent determinant for the onset of AF in multivariate analysis. Advanced stages of CKD (stages 4 and 5) were strongly related to the increased occurrence of AF.


CONCLUSIONS
The present study demonstrated that the complication of CKD, especially progressed renal dysfunction, was a powerful predictor of new-onset AF in hypertensive patients, independently of left ventricular hypertrophy and left atrial dilatation.
Horio
Takeshi
T
Division of Hypertension and Nephrology, Department of Medicine, National Cardiovascular Center, Suita, Japan. thorio@ri.ncvc.go.jp
Iwashima
Yoshio
Y
Kamide
Kei
K
Tokudome
Takeshi
T
Yoshihara
Fumiki
F
Nakamura
Satoko
S
Kawano
Yuhei
Y
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors
D000959:Antihypertensive Agents