Elsevier

American Heart Journal

Volume 159, Issue 6, June 2010, Pages 1102-1107
American Heart Journal

Clinical Investigation
Electrophysiology
Chronic kidney disease and prevalent atrial fibrillation: The Chronic Renal Insufficiency Cohort (CRIC)

https://doi.org/10.1016/j.ahj.2010.03.027Get rights and content

Background

The epidemiology of atrial fibrillation (AF) has been mainly investigated in patients with end-stage renal disease, with limited data on less advanced chronic kidney disease (CKD) stages.

Methods

A total of 3,267 adult participants (50% non-Hispanic blacks, 46% women) with CKD from the Chronic Renal Insufficiency Cohort were included in this study. None of the study participants had been on dialysis. Those with self-identified race/ethnicity other than non-Hispanic black or white (n = 323) or those without electrocardiographic data (n = 22) were excluded. Atrial fibrillation was ascertained by a 12-lead electrocardiogram and self-report. Age-, sex-, and race/ethnicity-specific prevalence rates of AF were estimated and compared between subgroups. Cross-sectional associations and correlates with prevalent AF were examined using unadjusted and multivariable-adjusted logistic regression analysis.

Results

The mean estimated glomerular filtration rate was 43.6 (±13.0) mL/(min 1.73 m2). Atrial fibrillation was present in 18% of the study population and in >25% of those ≥70 years old. In multivariable-adjusted models, 1-SD increase in age (11 years) (odds ratio 1.27, CI 95% 1.13-1.43, P < .0001), female sex (0.80, 0.65-0.98, P = .0303), smoking (former vs never) (1.34, 1.08-1.66, P = .0081), history of heart failure (3.28, 2.47-4.36, P < .001), and history of cardiovascular disease (1.94, 1.56-2.43, P < .0001) were significantly associated with AF. Race/ethnicity, hypertension, diabetes, body mass index, physical activity, education, high-sensitivity C-reactive protein, total cholesterol, and alcohol intake were not significantly associated with AF. An estimated glomerular filtration rate <45 mL/(min 1.73 m2) was associated with AF in an unadjusted model (1.35, 1.13-1.62, P = .0010), but not after multivariable adjustment (1.12, 0.92-1.35, P = .2710).

Conclusions

Nearly 1 in 5 participants in Chronic Renal Insufficiency Cohort, a national study of CKD, had evidence of AF at study entry, a prevalence similar to that reported among patients with end-stage renal disease and 2 to 3 times of that reported in the general population. Risk factors for AF in this CKD population do not mirror those reported in the general population.

Section snippets

Study population

The CRIC study is a prospective cohort of 3,612 participants with CKD. The study design and methods21 as well as the baseline cohort characteristics22 have been described elsewhere. Briefly, 7 clinical centers recruited adults who were aged 21 to 74 years and had CKD (but were not on dialysis) using age-based estimated glomerular filtration rate(eGFR) inclusion criteria (eGFR of 20 to 70, 60, or 50 mL/[min 1.73 m2] for age ranges 21-44, 45-64 and 65-74 years, respectively). Informed consent was

Results

Among the 3,267 participants included in this analysis, 1,627 were non-Hispanic white and 1,640 were non-Hispanic black (Table I). Mean age was 58.6 years, and 46% were women. More than 86% were hypertensive, 45% were diabetic, and 34% had a self-reported history of cardiovascular disease. The mean eGFR was 43.6 ±13.4 mL/(min 1.73 m2); approximately 55% of the study population had an eGFR <45 mL/(min 1.73 m2).

AF was present in 602 (18%) participants (Table II). Most AF cases were detected by

Discussion

This study addressed the prevalence and correlates of prevalent AF in a well-defined multiracial cohort of US individuals with CKD who are not receiving long-term dialysis treatments. Most of the previous studies that examined associations between AF and CKD were conducted either in ESRD patients on dialysis or in a general population sample, or were restricted to a single racial/ethnic group.10, 11, 12, 13, 32, 33 Our study revealed 3 main findings. First, the prevalence of AF was high in this

Acknowledgements

We thank the CRIC participants, staff, and investigators for their contributions to CRIC study.

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