Cardiovascular Events after New-Onset Atrial Fibrillation in Adults with CKD: Results from the Chronic Renal Insufficiency Cohort (CRIC) Study.
BACKGROUND
Atrial fibrillation (AF), the most common sustained arrhythmia in CKD, is associated with poor clinical outcomes in both patients without CKD and patients with dialysis-treated ESRD. However, less is known about AF-associated outcomes in patients with CKD who do not require dialysis.


METHODS
To prospectively examine the association of new-onset AF with subsequent risks of cardiovascular disease events and death among adults with CKD, we studied participants enrolled in the Chronic Renal Insufficiency Cohort Study who did not have AF at baseline. Outcomes included heart failure, myocardial infarction, stroke, and death occurring after diagnosis of AF. We used Cox regression models and marginal structural models to examine the association of incident AF with subsequent risk of cardiovascular disease events and death, adjusting for patient characteristics, laboratory values, and medication use.


RESULTS
Among 3080 participants, 323 (10.5%) developed incident AF during a mean 6.1 years of follow-up. Compared with participants who did not develop AF, those who did had higher adjusted rates of heart failure (hazard ratio [HR], 5.17; 95% confidence interval [95% CI], 3.89 to 6.87), myocardial infarction (HR, 3.64; 95% CI, 2.50 to 5.31), stroke (HR, 2.66; 95% CI, 1.50 to 4.74), and death (HR, 3.30; 95% CI, 2.65 to 4.12). These associations remained robust with additional adjustment for biomarkers of inflammation, cardiac stress, and mineral metabolism; left ventricular mass; ejection fraction; and left atrial diameter.


CONCLUSIONS
Incident AF is independently associated with two- to five-fold increased rates of developing subsequent heart failure, myocardial infarction, stroke, or death in adults with CKD. These findings have important implications for cardiovascular risk reduction.
['Bansal|Nisha|N|', 'Xie|Dawei|D|', 'Sha|Daohang|D|', 'Appel|Lawrence J|LJ|', 'Deo|Rajat|R|', 'Feldman|Harold I|HI|', 'He|Jiang|J|', 'Jamerson|Kenneth|K|', 'Kusek|John W|JW|', 'Messe|Steven|S|', 'Navaneethan|Sankar D|SD|', 'Rahman|Mahboob|M|', 'Ricardo|Ana Catherine|AC|', 'Soliman|Elsayed Z|EZ|', 'Townsend|Raymond|R|', 'Go|Alan S|AS|']
D000328:Adult D000368:Aged D001281:Atrial Fibrillation D002318:Cardiovascular Diseases D015331:Cohort Studies D005260:Female D006333:Heart Failure D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D011379:Prognosis D016016:Proportional Hazards Models D011446:Prospective Studies D051436:Renal Insufficiency, Chronic D012307:Risk Factors D020521:Stroke D014481:United States D055815:Young Adult
cardiovascular events heart failure chronic kidney disease