title: Estimated glomerular filtration rate within the normal or mildly impaired range and incident non-valvular atrial fibrillation: Results from a population-based cohort study.
abstract: Background Lower estimated glomerular filtration rate, in particular in the significant renal impairment range (estimated glomerular filtration rate <60 ml/min/1.73 m2), is associated with incident atrial fibrillation. This association is less established within the normal or mildly impaired estimated glomerular filtration rate range. Methods Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate formula, we identified ambulatory adults (>22 years old) without rheumatic heart disease or prosthetic valves and with 60 ml/min/1.73 m2<estimated glomerular filtration rate<130 ml/min/1.73 m2in their index visit, for incident, newly-diagnosed atrial fibrillation. We analyzed cohorts with and without prior cardiovascular disease. Results Over a mean follow-up of 104 months and >10 m patient-years of follow-up (∼75% <60 years old, ∼57% females), >65,000 individuals had ≥1 atrial fibrillation event (incident atrial fibrillation rate 5.1% and 5.8% excluding or including prior cardiovascular disease, or 49 and 55 per 10,000 patient-years, respectively). In both cohorts, individuals with versus without incident atrial fibrillation had lower mean estimated glomerular filtration rate (∼83 versus 95 ml/min/1.73 m2). Adjusting for age, gender, hypertension, and diabetes mellitus, overall a 10 ml/min/1.73 m2decrease in estimated glomerular filtration rate was independently associated with a mean increase in incident atrial fibrillation of 1.5% and 2.4% in the cohorts excluding or including prior cardiovascular disease, respectively ( p < 0.001 for both). However, a graded association between lower estimated glomerular filtration rate and atrial fibrillation was observed in the 90-130 ml/min/1.73 m2range, whereas a blunted association was observed in the 60-90 ml/min/1.73 m2range. Conclusion Within the 60 ml/min/1.73 m2< estimated glomerular filtration rate < 130 ml/min/1.73 m2range, lower estimated glomerular filtration rate is independently associated with incident non-valvular atrial fibrillation in adults without prior atrial fibrillation, mainly attributed to a graded association within the 90-130 ml/min/1.73 m2range.
authors: 1 Cardiology Department, Rabin Medical Center, Israel; affiliated to Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Alon
authors: A
authors: Eisen
authors: 2 Cardiology Department, Soroka medical center, Israel; affiliated to Ben Gurion University, Beer Sheva, Israel.
authors: Moti
authors: M
authors: Haim
authors: 3 Clalit Health Research Institute, Israel.
authors: Moshe
authors: M
authors: Hoshen
authors: 3 Clalit Health Research Institute, Israel.
authors: Ran D
authors: RD
authors: Balicer
authors: 3 Clalit Health Research Institute, Israel.
authors: Orna
authors: O
authors: Reges
authors: 3 Clalit Health Research Institute, Israel.
authors: Morton
authors: M
authors: Leibowitz
authors: 1 Cardiology Department, Rabin Medical Center, Israel; affiliated to Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Zaza
authors: Z
authors: Iakobishvili
authors: 1 Cardiology Department, Rabin Medical Center, Israel; affiliated to Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
authors: David
authors: D
authors: Hasdai
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: Kidney function; atrial fibrillation; creatinine; glomerular filtration rate; non-valvular