title: Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.
abstract: BACKGROUND
  Chronic kidney disease is associated with the incidence of cardiovascular disease. Chronic kidney disease may also increase the risk of atrial fibrillation (AF), but existing studies have reported inconsistent results.
  
  
  RESULTS
  We estimated cystatin C-based glomerular filtration rate (eGFR(cys)) and measured urinary albumin-to-creatinine ratio (ACR) in 10 328 men and women free of AF from the Atherosclerosis Risk in Communities (ARIC) Study in 1996 to 1998. Incidence of AF was ascertained through the end of 2007. During a median follow-up of 10.1 years, we identified 788 incident AF cases. Compared with individuals with eGFR(cys) ≥90 mL · min(-1) · 1.73 m(-2), multivariable hazard ratios and 95% confidence intervals (CIs) of AF were 1.3 (95% CI, 1.1 to 1.6), 1.6 (95% CI, 1.3 to 2.1), and 3.2 (95% CI, 2.0 to 5.0; P for trend <0.0001) in those with eGFR(cys) of 60 to 89, 30 to 59, and 15 to 29 mL · min(-1) · 1.73 m(-2), respectively. Similarly, the presence of macroalbuminuria (ACR ≥300 mg/g; hazard ratio, 3.2; 95% CI, 2.3 to 4.5) and microalbuminuria (ACR, 30 to 299 mg/g; hazard ratio, 2.0; 95% CI, 1.6 to 2.4) was associated with higher AF risk compared with those with ACR <30 mg/g. Risk of AF was particularly elevated in those with both low eGFR(cys) and macroalbuminuria (hazard ratio, 13.1; 95% CI, 6.0 to 28.6, comparing individuals with ACR ≥300 mg/g and eGFR(cys) of 15 to 29 mL · min(-1) · 1.73 m(-2) and those with ACR <30 mg/g and eGFR(cys) ≥90 mL · min(-1) · 1.73 m(-2)).
  
  
  CONCLUSIONS
  In this large population-based study, reduced kidney function and presence of albuminuria were strongly associated with the incidence of AF independently of other risk factors.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Minneapolis, MN 55454, USA. alonso@umn.edu
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Faye L
authors.initials: FL
authors.lastname: Lopez
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology