eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study.
BACKGROUND AND OBJECTIVES
The incidence of atrial fibrillation is high in ESRD, but limited data are available on the incidence of atrial fibrillation across a broad range of kidney function. Thus, we examined the association of eGFR and urine albumin-to-creatinine ratio with risk of incident atrial fibrillation.


DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We meta-analyzed three prospective cohorts: the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Cox regression models were performed examining the association of eGFR and urine albumin-to-creatinine ratio with incident atrial fibrillation adjusting for demographics and comorbidity. In additional analyses, we adjusted for measures of subclinical cardiovascular disease (by electrocardiogram and cardiac imaging) and interim heart failure and myocardial infarction events.


RESULTS
In the meta-analyzed study population of 16,769 participants without prevalent atrial fibrillation, across categories of decreasing eGFR (eGFR>90 [reference], 60-89, 45-59, 30-44, and <30 ml/min per 1.73 m2), there was a stepwise increase in the adjusted risk of incident atrial fibrillation: hazard ratios (95% confidence intervals) were 1.00, 1.09 (0.97 to 1.24), 1.17 (1.00 to 1.38), 1.59 (1.28 to 1.98), and 2.03 (1.40 to 2.96), respectively. There was a stepwise increase in the adjusted risk of incident atrial fibrillation across categories of increasing urine albumin-to-creatinine ratio (urine albumin-to-creatinine ratio <15 [reference], 15-29, 30-299, and ≥300 mg/g): hazard ratios (95% confidence intervals) were 1.00, 1.04 (0.83 to 1.30), 1.47 (1.20 to 1.79), and 1.76 (1.18 to 2.62), respectively. The associations were consistent after adjustment for subclinical cardiovascular disease measures and interim heart failure and myocardial infarction events.


CONCLUSIONS
In this meta-analysis of three cohorts, reduced eGFR and elevated urine albumin-to-creatinine ratio were significantly associated with greater risk of incident atrial fibrillation, highlighting the need for further studies to understand mechanisms linking kidney disease with atrial fibrillation.
['Bansal|Nisha|N|', 'Zelnick|Leila R|LR|', 'Alonso|Alvaro|A|', 'Benjamin|Emelia J|EJ|', 'de Boer|Ian H|IH|', 'Deo|Rajat|R|', 'Katz|Ronit|R|', 'Kestenbaum|Bryan|B|', 'Mathew|Jehu|J|', 'Robinson-Cohen|Cassianne|C|', 'Sarnak|Mark J|MJ|', 'Shlipak|Michael G|MG|', 'Sotoodehnia|Nona|N|', 'Young|Bessie|B|', 'Heckbert|Susan R|SR|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000419:Albuminuria D001281:Atrial Fibrillation D015415:Biomarkers D003404:Creatinine D055316:Cystatin C D018572:Disease-Free Survival D005260:Female D005919:Glomerular Filtration Rate D006333:Heart Failure D006801:Humans D015994:Incidence D053208:Kaplan-Meier Estimate D007668:Kidney D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D016016:Proportional Hazards Models D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D014481:United States D055815:Young Adult
albuminuria cardiovascular disease chronic kidney disease