title: Incident atrial fibrillation and risk of death in adults with chronic kidney disease.
abstract: BACKGROUND
  Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD); however, the long-term impact of development of AF on the risk of death among patients with CKD is unknown.
  
  
  RESULTS
  We studied adults with CKD (glomerular filtration rate <60 mL/min per 1.73 m(2) by the Chronic Kidney Disease Epidemiology Collaboration equation) identified between 2002 and 2010 who were enrolled in Kaiser Permanente Northern California and had no previously documented AF. Incident AF was identified using primary hospital discharge diagnoses or ≥2 outpatient visits for AF. Death was comprehensively ascertained from health plan administrative databases, Social Security Administration vital status files, and the California death certificate registry. Covariates included demographics, comorbidity, ambulatory blood pressure, laboratory values (hemoglobin, proteinuria), and longitudinal medication use. Among 81 088 adults with CKD, 6269 (7.7%) developed clinically recognized incident AF during a mean follow-up of 4.8±2.7 years. There were 2388 cases of death that occurred after incident AF (145 per 1000 person-years) compared with 18 865 cases of death during periods without AF (51 per 1000 person-years, P<0.001). After adjustment for potential confounders, incident AF was associated with a 66% increase in relative rate of death (adjusted hazard ratio 1.66, 95% CI 1.57 to 1.77).
  
  
  CONCLUSIONS
  Incident AF is independently associated with an increased risk of death in adults with CKD. Further study is needed to understand the mechanisms by which CKD is associated with AF and to identify potentially modifiable risk factors to decrease the burden of AF and subsequent risk of death in this high-risk population.
authors.affiliation: Division of Nephrology, University of Washington, Seattle, WA (N.B.).
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA (D.F., A.S.G.).
authors.forename: Dongjie
authors.initials: D
authors.lastname: Fan
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, CA (C.H.).
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA (J.D.O.).
authors.forename: Juan D
authors.initials: JD
authors.lastname: Ordonez
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA (D.F., A.S.G.) Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA (A.S.G.) Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA (A.S.G.).
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D017677:Age Distribution; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002140:California; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis
keywords: atrial fibrillation; kidney disease; mortality