title: Atrial fibrillation and incident end-stage renal disease: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
abstract: BACKGROUND
  Atrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD), however, the association between AF and incident ESRD has not been examined in the general United States population.
  
  
  METHODS
  A total of 24,953 participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified at baseline (2003-2007) from electrocardiogram data and self-reported history. Incident cases of ESRD were identified through linkage with the United States Renal Data System. Cox proportional-hazards regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between AF and incident ESRD.
  
  
  RESULTS
  A total of 2,155 (8.6%) participants had AF at baseline. Over a median follow-up of 7.4 years, 295 (1.2%) persons developed ESRD. In a model adjusted for demographics and potential confounders, AF was associated with an increased risk of incident ESRD (HR=1.51, 95% CI=1.08, 2.11). The association between AF and ESRD became non-significant after further adjustment for CKD markers (eGFR <60 mL/min/1.73 m(2) and urine albumin-to-creatinine ratio ≥ 30 mg/dL) (HR=1.24, 95% CI=0.89, 1.73).
  
  
  CONCLUSIONS
  AF is associated with an increased risk of ESRD in the general United States population and this association potentially is explained by underlying CKD.
authors: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: woneal@wakehealth.edu.
authors: Wesley T
authors: WT
authors: O'Neal
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Rikki M
authors: RM
authors: Tanner
authors: Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC, USA.
authors: Jimmy T
authors: JT
authors: Efird
authors: Department of Cardiology, Icahan School of Medicine at Mount Sinai, New York, NY, USA.
authors: Usman
authors: U
authors: Baber
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors: Alvaro
authors: A
authors: Alonso
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Virginia J
authors: VJ
authors: Howard
authors: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL, USA.
authors: George
authors: G
authors: Howard
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Paul
authors: P
authors: Muntner
authors: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.
authors: Elsayed Z
authors: EZ
authors: Soliman
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000208:ethnology*; D008297:Male; D011379:Prognosis; D044469:Racial Groups; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Atrial fibrillation; Epidemiology; Renal disease