title: Atrial Fibrillation and Risk of ESRD in Adults with CKD.
abstract: Atrial fibrillation frequently complicates CKD and is associated with adverse outcomes. Progression to ESRD is a major complication of CKD, but the link with atrial fibrillation has not been fully delineated. In this study, we examined the association of incident atrial fibrillation with the risk of ESRD in patients with CKD.
  
  
  
  We studied participants in the prospective Chronic Renal Insufficiency Cohort Study without atrial fibrillation at entry. Incident atrial fibrillation was identified by study visit ECGs, self-report, and hospital discharge diagnostic codes, with confirmation by physician adjudication. ESRD through 2012 was ascertained by participant self-report, medical records, and linkage to the US Renal Data System. Data on potential confounders were obtained from self-report, study visits, and laboratory tests. Marginal structural models were used to study the potential association of incident atrial fibrillation with risk of ESRD after adjustment for time-dependent confounding.
  
  
  
  Among 3091 participants, 172 (5.6%) developed incident atrial fibrillation during follow-up. During mean follow-up of 5.9 years, 43 patients had ESRD that occurred after development of incident atrial fibrillation (11.8/100 person-years) compared with 581 patients without incident atrial fibrillation (3.4/100 person-years). In marginal structural models with inverse probability weighting, incident atrial fibrillation was associated with a substantially higher rate of ESRD (hazard ratio, 3.2; 95% confidence interval, 1.9 to 5.2). This association was consistent across important subgroups by age, sex, race, diabetes status, and baseline eGFR.
  
  
  
  Incident atrial fibrillation was associated with higher risk of developing ESRD in CKD. Additional study is needed to identify potentially modifiable pathways through which atrial fibrillation was associated with a higher risk of progression to ESRD. More aggressive monitoring and treatment of patients with CKD and atrial fibrillation may improve outcomes in this high-risk population.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Kelvin
authors.initials: K
authors.lastname: Tao
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.forename: Edward
authors.initials: E
authors.lastname: Horwitz
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Radha Krishna
authors.initials: RK
authors.lastname: Kallem
authors.forename: Martin G
authors.initials: MG
authors.lastname: Keane
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Lora
authors.forename: Dominic
authors.initials: D
authors.lastname: Raj
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Louise
authors.initials: L
authors.lastname: Strauss
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Atrial Fibrillation; Electrocardiography; Humans; Kidney Failure, Chronic; Prospective Studies; Risk; cardiovascular disease; chronic kidney disease; diabetes mellitus; renal progression